California Licensed Incident Management Specialist

Job Summary

To support the resolution of grievances and appeals, the full-time California Licensed Incident Management Specialist will investigate cases, communicate with members and advocates, and prepare documentation for medical committees while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases by investigating and communicating with members
• Perform incident case management by analyzing case tracking databases and ensuring compliance with internal and external rules
• Provide customer service by delivering accurate information regarding case statuses and resolving issues for members in emotionally charged situations

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or related field, or equivalent experience
• Minimum of two (2) years of experience in health care, health insurance, or a directly related field
• Strong knowledge of health care compliance and incident management processes
• Experience in customer service or a related field for at least one (1) year
• Ability to manage complex cases and collaborate with cross-functional teams