Medical Claims Administrator

Imagine360; United States; A distancia; USD 42.000 - 56.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health plan options

Company-paid disability & life insure

Parental leave

PTO 20 days

Tuition reimbursement

401k contribution

Disability & life insurance

Professional development

Diversity & inclusion initiatives

Descripción de la vacante

Imagine360 is a health plan solutions company seeking a Medical Claims Administrator to coordinate the receipt, tracking, and documenting of stop loss claims submissions in a fully remote setting.

Responsibilities include processing claims, logging notices, compiling periodic reporting, and ensuring data accuracy for third-party administrators. This role emphasizes quality, cross-department collaboration, and process improvements.

Formación

• High school diploma or GED required; associates degree preferred
• 2+ years in administrative and customer service roles
• Understanding of Medical Third-Party Administration, claims, and terminology is preferred

Responsabilidades

• Coordinate stop loss claims submissions and enter into claims system
• Log potential claim notices and follow up with third-party administrator
• Prepare periodic reporting for stakeholders and ensure complete claim information
• Review and approve claims for funding with Finance and monitor quality trends
• Document claim files and collaborate across departments to improve processes

Conocimientos

Organizational skills

Problem-solving

Analytical skills

Detail oriented

Educación

High School Diploma or GED

Associates degree in Medical Billing and Coding

Herramientas

Microsoft Office

Descripción del empleo

Imagine360 is seeking a Medical Claims Administrator to join the team! The Medical Claims Administrator position coordinates the receipt, tracking, and documenting of stop loss claims submissions. Additional functions may include compiling reporting, communicating with third party administration staff, and processing claims. ITDA opportunities for HCOS from clients.

Position Location:100% remote

Responsibilities include but are not limited to:

• Stop Loss Claims Management
• Compiles stop loss claim submissions and enters in claims system.
• Logs potential claim notices.
• Ensures all claim information is included in submission and follows up with third party administrator when necessary.
• Properly documents claim file.
• Compile periodic reporting for various stakeholders.
• Claim Processing
• Review claims for appropriateness.
• Approve and facilitate funding with Finance.
• Quality Assurance
• Recognizes, documents, and alerts appropriate supervisor of trends.
• Performs self-quality monitoring in order to develop and execute plans to meet established goals.
• Provides ongoing feedback to help optimize quality performance.
• Collaborates with others and cross-departmentally to improve or streamline procedures.
• Develops new or improves current internal processes to improve quality

Required Experience/Education:

• High School Diploma or GED required
• Associates degree in Medical Billing and Coding or relative field
• 2+ years' experience in administrative and customer service
• Understanding of Medical Third-Party Administration functions, Claims and Medical terminology strongly preferred

Skills and Abilities:

• Working knowledge of computers and software including but not limited to Microsoft Office products
• Demonstrated organizational skills, problem-solving, analytical skills and detail oriented

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

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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.