Remote Medical Claims Specialist

Imagine360, LLC; United States; À distance; USD 55 000 - 75 000; Plein temps

Avantages offerts par ce poste

Health plan options

Company paid premiums for disability &

Parental Leave Policy

20 days PTO to start / 10 Paid Holls

Tuition reimbursement

401k company contribution

Disability & Life Insurance

Professional development opportunities

Diversity and inclusion initiatives

Résumé du poste

Imagine360, LLC is seeking a Medical Claims Administrator for a fully remote role in the United States. The position coordinates receipt, tracking, and documenting stop loss claims submissions and may involve compiling reporting and communicating with third-party administration staff.

ITDA opportunities for HCOS from clients. Responsibilities include stop loss claims management, processing, QA, and collaboration across departments to improve processes and quality.

Qualifications

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

Responsabilités

• 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

Connaissances

Microsoft Office

Organizational skills

Problem-solving

Detail-oriented

Formation

High School Diploma or GED

Associates degree in Medical Billing and Coding

Outils

Medical Claims software

Claims management system

Description du poste

Imagine360, LLC is seeking a Medical Claims Administrator for a fully remote role in the United States. The position coordinates receipt, tracking, and documenting stop loss claims submissions and may involve compiling reporting and communicating with third-party administration staff.

ITDA opportunities for HCOS from clients. Responsibilities include stop loss claims management, processing, QA, and collaboration across departments to improve processes and quality.