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 their advocates, and prepare documentation for medical committees, all while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases by investigating and communicating with members
• Perform case management activities, ensuring compliance with internal and external regulations
• Provide customer service by delivering accurate information and resolving issues related to health care delivery and benefits

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 minimum two (2) years of relevant experience, or five (5) years of experience in health care, health insurance, or a related field
• Knowledge of health care compliance and incident management processes
• Ability to manage complex relationships and stakeholder management
• Proficiency in Microsoft Office and data entry