California Licensed Incident Management Specialist

Job Summary

To support grievance and appeals resolutions, the full-time California Licensed Incident Management Specialist will manage case investigations, communicate with members and advocates, and prepare documentation for medical committees while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, ensuring compliance with regulations
• Investigate claims and customer service interactions to determine outcomes for moderately complex cases
• Provide customer service by communicating case statuses and resolving issues for members and stakeholders

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or related field, or equivalent experience
• Minimum one (1) year of experience in customer service or a related field
• Two (2) years of experience in health care, health insurance, or a directly related field, or five (5) years of relevant experience
• Knowledge of health care compliance and incident management processes
• Ability to manage complex cases and collaborate with cross-functional teams