Plan Analyst

Imagine360, LLC; United States; Remote; USD 60,000 - 85,000; Full time

Benefits offered by this job

Health plan options

Disability & Life insurance

Parental Leave Policy

Paid time off

Tuition reimbursement

401k matching

Professional development

Diversity & inclusion

Job summary

Imagine360, LLC is seeking a Plan Analyst to join the team. This role designs and implements new plan documents in the claims system and maintains a comprehensive understanding of the plans under their scope.

The position is 100% remote. Responsibilities include plan building, updating accumulators, interpreting plan language for EBMS departments, and supporting quality assurance and customer service.

Qualifications

• High school diploma or equivalent is required.
• Bachelor's degree preferred.
• 3+ years of Claims Examiner or plan building experience required.
• Familiarity with VBA, Javelina, and GBAS systems preferred.

Responsibilities

• Plan building and plan document design in the claims system.
• Builds and updates groups and adjusts system per amendments.
• Interpret plan language for EBMS departments and document changes.
• Provide internal customer service and escalate issues.
• Support quality assurance and testing for new clients.

Skills

Organizational skills

Problem-solving

Analytical skills

Detail oriented

Written communication

Oral communication

MS Office

Independent work

10-key typing

Education

High school diploma or equivalent

Bachelor's degree preferred

Tools

VBA

Javelina

GBAS

Job description

Imagine360 is seeking a Plan Analyst to join the team! This position constructs and implements new plan documents in the claims system. 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

• Plan building
  • Designs and implements system set up in accordance to plan document description.
  • Builds new groups and adjusts system per plan amendments in Claims system.
    • Documents applicable changes in related systems.
  • Determines benefits using ICD, CPT, HCP and Rev Codes in association with provider specialty, age, relationship, place of service and PPOs.
  • Updates accumulators for newly implemented groups.
• Plan Document Language
  • Ensures plan language conforms to the group's intent and claims build is properly constructed according to document.
  • Interprets and explains plan document language and plan designs for various EBMS departments.
• Customer Service
  • Receives and resolves internal inquiries regarding plan document language and design.
  • Provides timely and thorough follow up with, internal and external customers.
  • Appropriately escalates difficult issues up the chain of command.
  • Acts as a role model in demonstrating the core values in customer service delivery.
  • Trains and mentors new employees as assigned.
• Quality Assurance
  • Attends and participates in committee meetings and training sessions.
  • 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 staff and cross-departmentally to improve or streamline procedures.
  • Assists the Claim Department in performing plan design testing for new clients and renewing clients to assure quality output from the system.

Experience/Education

• High school diploma or equivalent required
• Bachelor's degree preferred
• 3+ years of Claims Examiner and/or plan building experience required
• Familiarity with VBA, Javelina, and/or GBAS system preferred

Skills and Abilities

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

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

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

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.