California Licensed Incident Management Specialist

Job Summary

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

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, ensuring compliance with regulations
• Conduct case management activities, including investigating claims and making determinations for moderately complex cases
• 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 related field
• Bachelor's degree in Business Administration, Health Care Administration, or a related field, plus 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
• Experience in negotiating and managing diverse relationships
• Proficiency in Microsoft Office and data entry