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 while working remotely.
Key responsibilities:
- Coordinate and monitor the resolution of grievances and appeals cases, ensuring compliance with regulations
- Conduct research and analysis on incident cases, making determinations based on claims and member contracts
- Provide customer service by communicating case statuses and resolving issues for members and stakeholders
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, or equivalent experience
- Minimum two (2) years of experience in health care, health insurance, or a directly related field
- Knowledge of health care compliance and incident management processes
- Strong interpersonal skills and ability to manage diverse relationships
Complete Job Description
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