California Licensed Incident Management Specialist

Job Summary

To enhance member satisfaction, the full-time California Licensed Incident Management Specialist will coordinate and monitor the resolution of grievances and appeals cases, investigate issues, and collaborate with cross-functional teams while working remotely.

Key responsibilities:

• Manage and resolve moderately complex grievances and appeals by investigating claims and collaborating with stakeholders
• Document case activities and ensure compliance with internal and external regulations
• Provide customer service by communicating effectively with members and addressing their concerns in a timely manner

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 health care, 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
• Ability to work independently and manage complex cases with minimal guidance