California Licensed Incident Management Specialist

Job Summary

Resolving grievances and appeals for members, the full-time California Licensed Incident Management Specialist will coordinate case investigations, communicate with members and advocates, and prepare documentation for medical committees while working remotely.

Key responsibilities:

• Manage and monitor the resolution of moderately complex grievances and appeals cases
• Collaborate with cross-functional teams to address member challenges related to health care delivery and benefits
• Document case management activities and ensure compliance with internal and external regulations

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or a related field, or equivalent experience
• Minimum of two (2) years of experience in health care, health insurance, or a directly related field
• At least one (1) year of experience in customer service or a related area
• Knowledge of health care compliance and incident management processes
• Ability to work independently and manage moderately complex cases effectively