Client Reimbursement Intake Specialist
Position Location: 100% remote
About the role
On behalf of clients and members, the Client Reimbursement Intake Specialist works to ensure plan members receive the healthcare services they need. The incumbent will work on the front line to educate providers and members on the full benefits of the health plan and helps to secure the care necessary to meet the needs of each case. The Specialist will also assist in matters related to member navigation and confirmation of benefits and member responsibility.
Understanding of Imagine360, its clients and plans—and Advocacy/Negotiation role therein—will be the key to success in this role.
Responsibilities
- Initiate primary provider outreach to explain plan benefits and, if possible, resolve case before reaching the Client Reimbursement Advocate.
- Educate members and providers on how the organization works with plans to successfully secure quality care when cases are passed to an Advocate.
- Research and confirm member benefits and responsibility as necessary.
- Review benchmark/Medicare rates for cases.
- When resolution cannot be secured with the provider, assist advocates and members to identify alternative provider options.
- Ensure smooth handoff of cases to Advocates by tracking and documenting all communications and efforts on assigned matters.
- Adhere to guidelines, escalate challenges for management review when needed, and maintain open and interactive communication with all key players.
- Champion on behalf of the member to ensure fair access to care using exceptional customer service skills.
Requirements
- Bachelor's Degree
- 1+ years of healthcare, health insurance, or customer service experience
- Experience with negotiations
- Experience in billing, insurance, healthcare, or legal environments is a plus
Skills
- Excellent communication (written, verbal, and listening), interpersonal, and analytic skills
- Knowledge and understanding of CMS1500 and UB04 Medical Claim Forms, medical coding, and proficiency in Microsoft Office products desired
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 / 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, 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.