California Licensed Incident Management Specialist

Job Summary

To support grievance and appeal resolutions, the full-time California Licensed Incident Management Specialist will coordinate 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, preparing documentation for medical committees
• Collaborate with cross-functional teams to resolve member-related issues and identify service gaps
• Conduct case research and documentation for moderately complex incident cases, ensuring compliance with internal and external regulations

Required Qualifications

• Minimum one (1) year of experience in customer service or a related field
• Bachelor's degree in Business Administration, Health Care Administration, or a related field, plus two (2) years of relevant experience, or five (5) years of experience in health care or related fields
• Knowledge of health care compliance and incident management processes
• Strong interpersonal skills and ability to manage diverse relationships
• Experience with data entry and maintaining confidential records