California Licensed Incident Management Specialist

Job Summary

To support the resolution of grievances and appeals cases, the full-time California Licensed Incident Management Specialist will investigate member issues, prepare documentation for medical committees, and collaborate with cross-functional teams to ensure compliance and satisfactory resolutions, all while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and preparing presentations for medical service determinations
• Collaborate with cross-functional partners to resolve member issues related to healthcare delivery and benefits
• Document and maintain confidentiality of case management activities while ensuring compliance with internal and external regulations

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, along with 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 complex relationships
• Proficiency in Microsoft Office and data entry