California Licensed Incident Management Specialist

Job Summary

To support the resolution of grievances and appeals, the full-time California Licensed Incident Management Specialist will manage case investigations, communicate with members and advocates, and ensure compliance with regulations while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate with cross-functional partners to resolve member issues related to healthcare delivery and benefits
• Perform case management by tracking, analyzing, and documenting incident cases while ensuring compliance with internal and external regulations

Required qualifications:

• Bachelor's degree in Business Administration, Economics, Health Care Administration, Health Services, Communications, or related field, or equivalent experience
• Minimum of two (2) years of experience in healthcare, health insurance, sales and marketing, or a directly related field
• At least one (1) year of experience in customer service or a related field
• Knowledge of healthcare compliance and incident management processes
• Ability to manage complex cases and collaborate effectively with diverse stakeholders