Incident Management Specialist III

Job Summary

To support the resolution of grievances and appeals, the full-time Incident Management Specialist III will coordinate case investigations, communicate with members and their advocates, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Manage and monitor the resolution of grievances and appeals cases, ensuring documentation is prepared for decision-making
• Collaborate with cross-functional teams to resolve member issues related to healthcare delivery and benefits
• Perform case research and documentation while maintaining confidentiality and compliance with internal and external requirements

Required qualifications:

• Minimum one (1) year of experience in customer service or a directly related field
• Bachelor's degree in Business Administration, Health Care Administration, or a related field AND minimum two (2) years of experience in health care or a directly related field, OR minimum five (5) years of relevant experience
• Knowledge of health care compliance and incident management processes
• Proficient in Microsoft Office and data entry
• Ability to manage complex situations and maintain effective relationships with stakeholders