Client Reimbursement Advocate

About the role

On behalf of clients and members, the Client Reimbursement Advocate works directly with providers to manage, negotiate, and resolve disputes to ensure fair and reasonable agreements on medical claims and services and to secure access to care for members. As the Client Reimbursement Advocate, your empathetic nature is essential as you advocate for members to minimize provider balance billing and denials of care. This is a 100% remote position.

Responsibilities

• Deliver specialized service over multiple channels by acting as a single point of contact, maintaining ownership of member resolution and navigating optimal care.
• Manage and coordinate elevated member issue resolution with confidence and a sense of urgency.
• Contact providers to negotiate single case agreements, monitor and maintain an assignment queue, and work with internal and external partners to resolve member access to care issues.
• Track and document all communications and efforts on assigned matters while meeting quality and production standards.
• Contact providers to resolve access to care issues and to explain medical plan pricing metrics.
• When resolution cannot be secured with the provider, assist members with identifying alternative provider options.
• Adhere to guidelines, escalate challenges for management review when needed, and maintain open and interactive communication with all key players to build sustainable relationships and trust with clients.
• Identify and execute on opportunities to negotiate settlements with providers, contact facilities upon request to educate them regarding the i360 process, and champion on behalf of the member to ensure fair access to care at reasonable cost.

Requirements

• Bachelor's degree preferred
• Minimum 1 year of healthcare, health insurance, or customer service experience

Skills and Abilities

• Excellent communication (written, verbal, and listening), interpersonal, and analytic skills
• Experience with negotiations preferred
• Knowledge and understanding of CMS1500 and UB04 Medical Claim Forms, medical coding, and proficiency in Microsoft Office products desired
• Experience in billing, insurance, healthcare, or legal environments is a plus

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- and long-term disability plus life insurance
• Professional development initiatives and continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

About Imagine360

Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, the company has helped thousands of employers save billions on healthcare. Their total health plan solution addresses the limitations of one-size-fits-none PPO insurance with powerful, customized, member-focused solutions.