Claims Examiner

Imagine360, LLC; United States; Remote; USD 40,000 - 60,000; Full time

Job summary

A healthcare solutions company is seeking a Claims Examiner to efficiently process medical claims while working remotely. Candidates need a high school diploma, with preference for those having experience in medical settings. Strong communication and organizational skills are crucial for succeeding in this role, which offers multiple health plan options and professional development opportunities.

Benefits

Multiple Health Plan Options

Company paid premiums for disability

Parental Leave Policy

20 days PTO to start

Tuition reimbursement

401k Company contribution

Continuous learning opportunities

Diversity and inclusion initiatives

Qualifications

• 1+ years' experience in clerical and customer service positions.
• Knowledge of medical terminology is preferred.
• TPA experience is a plus.

Responsibilities

• Process and manage claims including interpretation of plan documents.
• Investigate suspicious claims to prevent fraud.
• Maintain communication with other departments regarding claims.
• Respond to inquiries of moderate complexity.

Skills

Computer knowledge

Mathematical skills

Problem-solving

Organizational skills

Communication skills

Education

High school diploma or GED

Associate degree in Medical Billing and Coding

Tools

Microsoft Office products

Job description

Imagine360 is currently seeking a Claims Examiner! This Claims Examiner properly applies plan provisions on self-funded groups. This position is responsible for claims processing of medical, dental and vision claims, and answers questions in accordance with relevant terms and established procedures. This individual works closely with other departments to proactively research concerns and resolve to the satisfaction of the client. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Claims Processing
  • Interprets plan documents.
  • Reviews, researches, and analyzes information to determine eligibility.
  • Processes, denies, pends, or allows claims.
  • Uses thought and reasoning to manage workload that carries an average level of financial risk.
  • Identify and investigate suspicious claims to prevent fraud and abuse.
  • Responsible for meeting or exceeding production and quality standards.
  • Research, resolve and respond to inquiries and problems of a moderately complex nature.
  • Follow documented claims policies and procedures
  • Interface with other departments, when necessary, regarding claims issues.
  • Participate in Claims Department staff meetings, and other activities as needed.
• Correspondence
  • Accurately notes the system of all information received.

Required Experience / Education:

• High school diploma or GED
• 1+ years' experience in clerical and customer service positions

Preferred Experience / Education:

• Associate degree in Medical Billing and Coding or related field
• Claims or Medical Office experience. Knowledge of medical terminology.
• TPA experience

Skills and Abilities:

• Working knowledge of computers and software including but not limited to Microsoft Office products
• Proficient mathematical, 10-key and typing skills
• Demonstrated organizational skills, problem-solving, analytical skills and detail oriented
• Demonstrated ability to remain neutral and maintain confidentiality
• Strong written and oral communication skills
• Demonstrated ability to work independently, prioritize workloads multi-task and manage priorities in order to meet deadlines

What can Imagine360 offer you?

• Multiple Health Plan Options
• Company paid employee premiums for disability, and Life Insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

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Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**