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 their advocates, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, preparing documentation for medical committees
• Collaborate cross-functionally to resolve member issues related to health care delivery and benefits
• Perform case management and documentation for moderately complex incident cases, ensuring compliance with internal and external regulations

Required qualifications:

• 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
• At least one (1) year of experience in customer service or a related area
• Knowledge of health care compliance and incident management processes
• Ability to manage complex relationships and effectively communicate with diverse stakeholders