Incident Management Specialist III, Resolution Specialist- Must live in GA, CO, WA, CA, MAS

In addition to the responsibilities listed below, this position also processes escalations with an elevated level of complexity with a heightened level of resolution by contributing to the collaboration between a variety of internal (Appointment Centers, Claims, Membership Services, Pharmacy, Care Delivery, Referrals and Precertification) and external entities (Third Party Administration, Providers & Provider Networks, Directories) to ensure care and plan administration needs are met; resolving moderately complex issues for members related to health care delivery or financial barriers by working with cross functional partners to facilitate process improvement initiatives to resolve member challenges; leveraging comprehensive foundational knowledge of KPs products and services to act as a member ambassador by ensuring that members understand the plan they purchased, understand the value of Kaiser Permanente care, integrate into the KP delivery system, and know how to get started using the provider directory to find doctors, facilities, and pharmacies; independently scheduling select medical appointments or consultations; and addressing executive level requests for service models to handle unique member scenarios.

• Pursues effective relationships with others by proactively providing resources, information, advice, and expertise with coworkers and members. Listens to, seeks, and addresses performance feedback; provides mentoring to team members. Pursues self-development; creates plans and takes action to capitalize on strengths and develop weaknesses; influences others through technical explanations and examples. Adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; helps others adapt to new tasks and processes. Supports and responds to the needs of others to support a business outcome.


• Completes work assignments autonomously by applying up-to-date expertise in subject area to generate creative solutions; ensures all procedures and policies are followed; leverages an understanding of data and resources to support projects or initiatives. Collaborates cross-functionally to solve business problems; escalates issues or risks as appropriate; communicates progress and information. Supports, identifies, and monitors priorities, deadlines, and expectations. Identifies, speaks up, and implements ways to address improvement opportunities for team.


• Performs member, customer, or employee incident case management by: monitoring and analyzing the case tracking database to identify moderately complex, specialty, or flagged cases that require resolution as well as reporting trends to management; processing moderately complex and specialty/flagged incident cases; and ensuring compliance of own work with internal and external rules in the performance of case management activities with some review necessary.


• Performs member or employee incident case research by: investigating claims, authorizations, member contracts, and/or customer service interactions across members and customers to make determinations for moderately complex and specialty or flagged incident cases.


• Resolves member or employee incident cases by: making decisions regarding moderately complex or specialty/flagged incident cases through interacting with business leaders and other stakeholders; and resolving moderately complex or specialty/flagged cases and implementing case decisions.


• Performs customer service by: providing accurate information to members, customers, employees, or other stakeholders related to the status and outcomes of moderately complex or specialty/flagged cases in an appropriate timeframe; and communicating with and diffusing frustrated members, customers, or other stakeholders in moderately complex or specialty/flagged cases involving highly charged, sometimes emotional situations.


• Performs case documentation by: maintaining confidentiality of member, customer, or employee information throughout numerous documentation activities for moderately complex or specialty/flagged cases; and documenting moderately complex or specialty/flagged cases in accordance with all internal and external requirements.