Client Reimbursement Intake Specialist

Imagine360; United States; Remote; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health plan options

Disability & life insurance (company‑p

Parental Leave Policy

PTO 20 days

Tuition reimbursement

401k Company contribution

Professional development

Job summary

Imagine360 is seeking a Client Reimbursement Intake Specialist to educate providers and members on plan benefits and secure necessary care. The incumbent will work on the front line to educate providers and members on the full benefits of the health plan and helps to secure the care necessary to meet the needs of each case.

Remote position serving US clients and coordination with Advocates. You will also assist in member navigation and confirmation of benefits and member responsibility, with

Qualifications

• Bachelor's Degree required.
• 1+ years of healthcare, health insurance, or customer service experience.
• Experience with negotiations.
• Experience in billing, insurance, healthcare, or legal environments is a plus.

Responsibilities

• Understand Imagine360, its clients and plans, and the Advocacy/Negotiation role therein.
• Initiate provider outreach to explain plan benefits and resolve cases before escalation.
• Educate members on plan benefits and how we work with plans to secure quality care.
• Research and confirm member benefits and responsibility as necessary.
• Review benchmark/Medicare rates for cases.
• Assist advocates and members to identify alternative provider options when needed.
• Ensure smooth handoff of cases to Advocates by tracking and documenting communications.
• Maintain open communication with key players and uphold guidelines to build trust and fair access to care.

Skills

Excellent communication

CMS1500/UB04 knowledge

Microsoft Office proficiency

Negotiation experience

Education

Bachelor's Degree

Job description

Imagine360 is seeking a Client Reimbursement Intake Specialist to join the team! On behalf of clients and members, the Client Reimbursement Intake Specialist works to ensure plan members receive the healthcare services they need. The incumbent will work on the front line to educate providers and members on the full benefits of the health plan and helps to secure the care necessary to meet the needs of each case. The Specialist will also assist in matters related to member navigation and confirmation of benefits and member responsibility.

Position Location

100% remote

Responsibilities include but are not limited to

• Understanding of Imagine360, its clients and plans-and Advocacy/Negotiation role therein-will be the key to success in this role.
• Initiate primary provider outreach to explain plan benefits and if possible, resolve case before reaching the Client Reimbursement Advocate.
• Should the case be passed on to an Advocate, member and provider will need to be educated on how we work with plans to successfully secure quality care.
• Research and confirm member benefits and responsibility as necessary.
• Review benchmark/Medicare rates for cases.
• When resolution cannot be secured with the provider, you assist advocates and members to identify alternative provider options.
• Ensure smooth handoff of cases to Advocates by tracking and documenting all communications and efforts on assigned matters.
• In order to build sustainable relationships and trust with clients, you adhere to guidelines, elevate challenges for management review when needed, and maintain open and interactive communication with all key players. With your exceptional customer service skills, you will champion on behalf of the member to ensure fair access to care.

Required Experience/Education

• Bachelor's Degree
• 1+ years of healthcare, health insurance, or customer service experience.
• Experience with negotiations.
• Experience in billing, insurance, healthcare, or legal environments is a plus.

Skills and Abilities

• Excellent communication (written, verbal, and listening), interpersonal, and analytic skills
• Knowledge and understanding of CMS1500 and UB04 Medical Claim Forms, medical coding, and proficiency in Microsoft Office products desired

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
• Company paid Short & Long term Disability plus Life Insurance
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

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**