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 by investigating cases and preparing documentation for medical committees
• Resolve member and employee incident cases by making decisions and collaborating with cross-functional partners to address complex issues
• Maintain accurate case documentation and ensure compliance with internal and external regulations throughout the case management process

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
• At least one (1) year of experience in customer service or a related field
• Knowledge of health care compliance and incident management processes
• Experience with data entry and maintaining records in compliance with regulations