California Licensed Incident Management Specialist

Job Summary

To support effective grievance and appeal resolutions, 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:

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and preparing documentation for medical committees
• Collaborate cross-functionally to resolve member issues related to healthcare delivery and benefits
• Document case management activities and maintain confidentiality while ensuring compliance with internal and external regulations

Required qualifications:

• Bachelor's degree in Business Administration, Health Care Administration, or a related field, or five years of relevant experience
• Minimum one year of experience in customer service or a directly related field
• Knowledge of health care compliance and incident management processes
• Experience in negotiating and managing diverse relationships
• Proficiency in Microsoft Office and data entry