Job Description

Imagine360 is currently seeking a Claims Correspondence Review Specialist. This role of Client Claims Review (CCR) Specialist is a client facing role assisting the client by answering questions and resolving issues related to claims. The position performs research to accurately respond to inquiries from both internal and external customers. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.

Position Location Open to remote

Responsibilities include but are not limited to:

• Claims Review
  • Understand and review claims processing.
  • Interpret plan documents.
  • Review, research, and analyze information to determine eligibility.
  • Perform outbound telephone calls to assist in obtaining the required information to process a claim.
  • Work with the Claims Examiner to resolve claims processing issues.
• Customer Service
  • Provide acknowledgement and resolution to email questions within 8 hours or, provide customer with ETA and explanation for delay. When resolution cannot be completed in 8 hours, an ETA will be provided.
  • Respond to and resolve urgent issues in a timely manner.
  • Answer phone calls from the CSR team and Account management
  • Regularly checks and prioritize voicemails on an hourly basis and reply in a timely manner (no more than 8 hours).
  • Act as a role model in demonstrating the core values in customer service delivery.
  • Provide timely and thorough follow up with, internal and external customers.
  • Track and return telephone calls/mail to members and groups answering specific plan/claim questions within 24 hours.
• Quality Assurance
  • Perform self-quality monitoring to develop and execute plans to meet established goals.
  • Recognize and notify appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
  • Collaborate with others and cross-departmentally to improve or streamline procedures.

Required Experience / Education:

• High School Diploma or equivalent.
• 2 years of claims examiner and/or customer service experience

• Proficient 10-key and typing skills.
• Demonstrated self-motivation, organizational skills, problem-solving skills.
• Strong written and oral communication skills with attention to detail and accuracy
• Demonstrated ability to remain neutral and maintain confidentiality.

What can Imagine360 offer you?

• Multiple Health Plan Options, including a 100% Employer Paid Benefit Options
• 100% Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives

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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.

Imagine360 is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited, and no fee will be payable. Thank you for your cooperation**