California Licensed Incident Management Specialist

Job Summary

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

Key responsibilities:

• Manage and monitor the resolution of grievances and appeals cases, preparing documentation for medical committees
• Collaborate with cross-functional teams to resolve complex member issues related to healthcare delivery and benefits
• Document and maintain confidentiality of case information while ensuring compliance with internal and external regulations

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or related field, or equivalent experience
• Minimum of two (2) years of experience in healthcare, health insurance, or a related field
• At least one (1) year of experience in customer service or a directly related field
• Knowledge of health care compliance and incident management processes
• Experience in data entry and maintaining accurate records