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 and monitor 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 by investigating cases and preparing documentation for medical committees
• Collaborate with cross-functional teams to resolve member issues related to healthcare delivery and benefits
• Document case management activities while maintaining confidentiality and ensuring compliance with internal and external regulations

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or a related field, along with two years of relevant experience, or five years of experience in health care or health insurance
• Minimum one year of experience in customer service or a directly related field
• Knowledge of health care compliance and incident management processes
• Experience with data entry and maintaining accurate records
• Ability to manage diverse relationships and resolve conflicts effectively