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 prepare documentation for medical committees, all while working remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, ensuring compliance with regulations
• Investigate claims and member interactions to make determinations 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 a related field, or equivalent experience
• Minimum of two (2) years of experience in health care, health insurance, or a directly related field
• At least one (1) year of experience in customer service or a related area
• Knowledge of health care compliance and incident management processes
• Ability to manage complex relationships and provide effective resolutions