Remote Appeals & Claims Review Specialist

Imagine360, LLC; United States; Remote; USD 45.000 - 65.000; Vollzeit

Benefits dieser Stelle

Multiple Health Plan Options

Company paid employee premiums for dis

Life Insurance

Parental Leave Policy

PTO 20 days to start

10 Paid Holidays

Tuition reimbursement

401k Company contribution

Professional development initiatives

Diversity and inclusion initiatives

Zusammenfassung

Imagine360 is seeking an Appeals Review Specialist to join our team in a fully remote capacity. The role focuses on reviewing provider claims for errors, ensuring plan assets are protected, and maintaining alignment with plan documents.

You will handle appeals, respond to members and providers in writing or by phone, explain denials, and train staff to improve review quality. A high school diploma and at least two years in healthcare claims are required.

Qualifikationen

• Minimum two years of healthcare claims examining or related work experience.
• Proficient in reviewing claims for accuracy against medical records.
• Ability to respond to members and providers in writing and by phone.
• Demonstrates neutrality and maintains confidentiality.
• Familiarity with denial explanations and appeal processes.

Aufgaben

• Review claims edits and verify accuracy against medical records.
• Respond to inquiries and provide denial explanations.
• Train claims staff to improve review quality.
• Escalate complex issues to management when needed.
• Ensure regulatory compliance standards are maintained.

Kenntnisse

Healthcare claims review

Microsoft Office

10-key data entry

Typing skills

Written and verbal communication

Attention to detail

Confidentiality

Ausbildung

High school diploma or equivalent

Jobbeschreibung

Imagine360 is seeking an Appeals Review Specialist to join our team in a fully remote capacity. The role focuses on reviewing provider claims for errors, ensuring plan assets are protected, and maintaining alignment with plan documents.

You will handle appeals, respond to members and providers in writing or by phone, explain denials, and train staff to improve review quality. A high school diploma and at least two years in healthcare claims are required.