California Licensed Incident Management Specialist

Job Summary

To support effective 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:

• Manage the resolution of moderately complex grievances and appeals cases, collaborating with cross-functional teams
• Conduct thorough investigations of claims and customer interactions to determine case outcomes
• Document case activities and maintain confidentiality while ensuring compliance with internal and external regulations

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or related field, plus two years of relevant experience, or five years of experience in health care or related fields
• Minimum one year of experience in customer service or a directly related field
• Knowledge of health care compliance and incident management processes
• Ability to handle moderately complex cases and make decisions based on policy and guidelines
• Proficiency in Microsoft Office and data entry skills