Dispute Selection Specialist

Imagine360; United States; On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Health plan options

Disability & Life insurance

Parental leave

Paid time off

Tuition reimbursement

401k match

Professional development

Diversity & inclusion

Job summary

Imagine360, a health plan solution company, is seeking a Dispute Selection Specialist to handle No Surprises Act claims through the CMS IDR portal. Remote work is supported, enabling research, eligibility checks, and case closure with HIPAA-compliant practices.

The role emphasizes responding to IDR notices, researching claims for NSA eligibility, meeting daily production goals, and collaborating with internal/external partners.

Qualifications

• Bachelor's degree preferred.
• Minimum 1 year of healthcare, health insurance, or customer service experience.
• Knowledge of CMS1500 and UB04 medical claim forms.
• Experience in billing, insurance, healthcare, or legal environments is a plus.

Responsibilities

• Respond to Independent Dispute Resolution (IDR) requests in the IDR portal.
• Research claims to confirm eligibility for handling according to the No Surprises Act (NSA).
• Close cases based on the IDR determinations.
• Assist management with various tasks and assignments.
• Triage inquiries and questions from internal and external partners.
• Report any system issues.
• Meet daily production goals and performance objectives.
• Adhere to HIPAA guidelines and regulations.
• Other projects and duties as assigned.

Skills

Communication

Negotiation

CMS1500/UB04

Billing

Microsoft Office

Education

Bachelor's degree preferred

Tools

MS Office Suite

Job description

Imagine360 is seeking a Dispute Selection Specialist to join the team! The Dispute Selection Specialist role, you will be responsible for essential handling of No Surprises Act claims. This will include researching claims for eligibility and reviewing and analyzing trends and data to strategically respond to Independent Dispute Resolution (IDR) notices in the CMS Portal.
Position Location: 100% remote

• Responsibilities include but are not limited to:
• Respond to Independent Dispute Resolution (IDR) requests in the IDR portal.
• Research claims to confirm eligibility for handling according to the No Surprises Act (NSA).
• Close cases based on the IDR determinations.
• Assist management with various tasks and assignments.
• Triage inquiries and questions from internal and external partners.
• Report any system issues.
• Meet daily production goals and performance objectives.
• Adhere to HIPAA guidelines and regulations.
• Other projects and duties as assigned.
  

Required Experience/Education:

• Bachelor's degree preferred
• Minimum 1 year of healthcare, health insurance, or customer service experience
  

Skills and Abilities:

• Excellent communication (written, verbal, and listening), interpersonal, and analytic skills
• Experience with negotiations preferred
• Knowledge and understanding of CMS1500 and UB04 Medical Claim Forms, medical coding, and proficiency in Microsoft Office products desired
• Experience in billing, insurance, healthcare, or legal environments is a plus!
  

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