California Licensed Incident Manager

Job Summary

To support effective grievance and appeal resolutions, the full-time California Licensed Incident Manager will investigate and communicate with members, prepare documentation for medical committees, and collaborate with cross-functional teams to address complex case issues remotely.

Key responsibilities:

• Coordinate and monitor the resolution of grievances and appeals cases, ensuring compliance with regulations
• Investigate claims and customer interactions to make determinations on 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 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 handle moderately complex cases and communicate effectively with various stakeholders