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 management activities, investigate issues, and collaborate with cross-functional teams in a remote work environment.

Key responsibilities:

• Manage and monitor the resolution of grievances and appeals cases, ensuring compliance with internal and external regulations
• Conduct thorough investigations of claims and authorizations to determine outcomes for moderately complex incident cases
• Provide customer service by communicating effectively with members and stakeholders regarding case statuses and resolutions

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 AND minimum two (2) years of experience in health care or health insurance
• Alternatively, a minimum of five (5) years of experience in health care, health insurance, sales, or marketing
• Knowledge of health care compliance and incident management processes
• Experience in negotiating and managing diverse relationships within a healthcare setting