California Licensed Incident Management Specialist

Job Summary

Resolving grievances and appeals cases, the full-time California Licensed Incident Management Specialist will investigate issues, communicate with members and advocates, and prepare documentation for medical committees while working remotely.

Key Responsibilities

• Coordinate and monitor the resolution of grievances and appeals by investigating cases and preparing presentations for medical service determinations
• Collaborate with cross-functional teams to resolve member-related issues and ensure compliance with internal and external regulations
• Document and maintain confidentiality of member information while managing moderately complex incident cases

Required Qualifications

• Minimum one (1) year of experience in customer service or a directly related field
• Bachelor's degree in Business Administration, Health Care Administration, or a related field AND a minimum of two (2) years of experience in health care or health insurance
• Alternatively, minimum five (5) years of experience in health care, health insurance, sales, or marketing
• Knowledge of health care compliance and incident management processes
• Proficiency in Microsoft Office and data entry