Incident Management Specialist III

Job Summary

To support the resolution of grievances and appeals, the full-time Incident Management Specialist III will manage case investigations, communicate with members and advocates, and prepare documentation for medical committees while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and preparing relevant documentation
• Collaborate cross-functionally to resolve member issues related to healthcare delivery, benefits, and financial barriers
• Perform case management activities, ensuring compliance with internal and external regulations while documenting case outcomes

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, with at least two (2) years of relevant experience, or five (5) years of experience in healthcare or health insurance
• Knowledge of health care compliance and incident management processes
• Experience in negotiation and stakeholder management
• Proficiency in Microsoft Office and data entry