Marita Grimes
Incident Management Specialist Iii @Kaiser Permanente
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WORK HISTORY
Incident Management Specialist Iii @Kaiser Permanente
Coordinate and monitor the resolution of grievances and appeals cases by investigating, communicating with members and their advocates both verbally and in writingPreparing presentations of all relevant documentation to medical committees for medical service determinations and reconsiderationsIdentify and partner with appropriate entities to process escalations with an elevated level of complexity and a heightened level of resolutionReview cases and confirm documentation is prepared for decision making processesLeverage a comprehensive foundational knowledge of the product/service domain to contribute to satisfactory resolutions of moderately complex customer and member grievances and appeals with appropriate groups and departments (e.g, Medical Group, Health Plan)Resolve issues for members related to health care delivery, benefits, or financial barriers by collaborating with cross functional partners and leaders in order to resolve member challengesRecognize service gaps that contribute to dissatisfaction among customers, members, key stakeholders and/or functional areas with minimal guidanceMake decisions on appropriate case types using their own critical thinking taking into account policy and guidelinesEnsure that all case management activities are compliant with external regulations and responses to regulators
EDUCATION
Orange Coast College
Associate's Degree
SKILLS
ABOUT MARITA GRIMES
Service-oriented business professional offering experience in office management, administration, customer/ client relations, human resources, marketing, accounting and oversight of company policies, while utilizing my proactive leadership skills and maintaining positive relationships with associates.
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