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 advocates, and prepare documentation for medical committees, all while working remotely.

Key responsibilities:

• Manage and monitor the resolution of moderately complex grievances and appeals cases, ensuring compliance with regulations
• Conduct thorough case research by investigating claims, authorizations, and customer service interactions
• Provide customer service by communicating case status and outcomes to members and stakeholders in a timely manner

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or a related field, along with a minimum of two years of relevant experience, or five years of experience in health care or health insurance
• At least one year of experience in customer service or a directly related field
• Knowledge of health care compliance and incident management processes
• Proficiency in Microsoft Office and data entry
• Ability to manage complex cases and maintain confidentiality of sensitive information