California Licensed Incident Management Specialist
Job Summary
To support the resolution of grievances and appeals, the full-time California Licensed Incident Management Specialist will coordinate case investigations, 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 cases, ensuring compliance with regulations
- Investigate claims and customer service interactions to make determinations on moderately complex cases
- Provide accurate information and support to members and stakeholders regarding case statuses and outcomes
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, or equivalent experience
- Minimum two (2) years of experience in health care, health insurance, or a directly related field, or five (5) years of relevant experience
- Knowledge of health care compliance and incident management processes
- Experience in negotiating and managing diverse relationships
Complete Job Description
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