California Licensed Incident Management Specialist

Job Summary

To support the resolution of grievances and appeals, the full-time California Licensed Incident Management Specialist will coordinate case investigations, communicate with members and their advocates, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Investigate and monitor grievances and appeals cases, preparing documentation for medical committees
• Collaborate with cross-functional teams to resolve member issues related to health care delivery and benefits
• Document case management activities and ensure compliance with internal and external regulations

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 AND two (2) years of experience in health care or a directly related field, OR five (5) years of relevant experience
• Knowledge of health care compliance and incident management processes
• Experience with data entry and maintaining records
• Strong interpersonal skills and ability to manage diverse relationships