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 advocates, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, preparing documentation for medical committees
• Perform incident case management by analyzing case tracking databases and resolving moderately complex cases
• Provide customer service by communicating case statuses and outcomes to members and stakeholders in a timely manner

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 related field, with two (2) years of relevant experience, or five (5) years of experience in health care or health insurance
• Knowledge of health care compliance and incident management processes
• Ability to manage complex relationships and effectively communicate with diverse stakeholders
• Proficient in Microsoft Office and data entry related to case documentation