Incident Management Specialist III

Job Summary

Resolving grievances and appeals cases, the full-time Incident Management Specialist III will manage case investigations, collaborate with cross-functional teams, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with stakeholders to resolve member-related issues and identify service gaps contributing to dissatisfaction
• Perform incident case management and research, ensuring compliance with internal and external regulations while documenting case activities

Required qualifications:

• Minimum one (1) year of experience in customer service or a directly related field
• Bachelor's degree in Business Administration, Economics, Health Care Administration, Health Services, Communications, or related field AND minimum two (2) years of experience in health care or related fields, OR minimum five (5) years of relevant experience
• Knowledge of health care compliance and incident management processes
• Ability to manage complex relationships and effectively communicate with diverse stakeholders
• Experience with data entry and maintaining confidential records