Plan Analyst

About the role

Imagines360 is seeking a Plan Analyst to join the team. This position constructs and implements new plan documents in the claims system and maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.

Responsibilities

• 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.
• Aids the Claim Department in performing plan design testing for new clients and renewing clients to assure quality output from the system.

Requirements

• 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.

Qualifications

• 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.

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.

Pay

Details about pay are not specified in the job posting.

Schedule

The position is 100% remote.