Plan Design Specialist

Imagine360; United States; Remote; USD 50,000 - 145,000; Full time

Job summary

Imagine360 is seeking a Plan Design Specialist to join their team fully remotely. The role includes building and implementing new plan documents in the claims system, ensuring compliance with plan intent, and providing exceptional customer service. Ideal candidates will have extensive experience in claims examination and strong analytical skills.

Benefits

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

Qualifications

• 3+ years of Claims Examiner and/or plan building experience required.
• Familiarity with VBA, Javelina, and/or GBAS system preferred.

Responsibilities

• Constructs and implements new plan documents in the claims system.
• Receives and resolves internal inquiries regarding plan document language and design.
• Collaborates with staff to improve or streamline procedures.

Skills

Organizational skills

Problem-solving

Analytical skills

Detail oriented

Communication skills

Microsoft Office proficiency

Education

High school diploma or equivalent

Bachelor's degree

Job description

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Join to apply for the Plan Design Specialist role at Imagine360

Imagine360 is seeking a Plan Design Specialist 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
  
  
  

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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**

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Design, Art/Creative, and Information Technology

• Industries

  Insurance

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