Incident Management Specialist III

Job Summary

Seeking a full-time Incident Management Specialist III, the role involves coordinating and monitoring the resolution of grievances and appeals, investigating cases, and collaborating with cross-functional teams to ensure satisfactory outcomes while working remotely.

Key responsibilities:

• Manage the resolution of moderately complex grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with internal and external stakeholders to resolve member-related issues and ensure compliance with regulations
• Document and track case management activities, maintaining confidentiality and adhering to internal and external requirements

Required qualifications:

• Minimum one (1) year of experience in customer service or a related field
• Bachelor's degree in Business Administration, Health Care Administration, or a related field, along with two (2) years of relevant experience, or five (5) years of experience in health care or health insurance
• Knowledge of health care compliance and incident management processes
• Strong interpersonal skills and ability to manage diverse relationships
• Experience with conflict resolution and customer service in emotionally charged situations