Job Description

Imagine360 is seeking a Client Reimbursement Advocate to join the team!  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.

Position Location: 100% remote

Responsibilities include but are not limited to:

• The primary goal for this role is to solve access to care issues for members and clients while providing frequent updates and final resolutions to all relevant stakeholders, including the members and clients themselves, as well as department leadership, account managers, clinical team, and any other relevant players specific to each case.
• Contact providers to explain medical plan pricing metrics and troubleshoot any barriers to entry for members and clients, including negotiating pre-payments and single-case agreements.
• Initiate and maintain contact with members to introduce ourselves, establish trust that we will resolve their case, and provide relevant updates throughout the life of their case.
• Provide regular updates to multiple partners inside and outside the organization to ensure relevant stakeholders are up to date with each case.
• When resolution cannot be secured with the provider, you assist members with identifying alternative provider options.
• Meet quality and production standards.
• Track and document all communications that relate to the claims and settlement negotiations.
• Adhere to guidelines, escalate claims for management review when needed, and maintain open and interactive communication with all key players.
• With your exceptional customer service skills, you identify and execute 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.

Required Experience/Education:

• High School Diploma or GED
• 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 and Abilities:

• 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 

What can Imagine360 offer you?

• 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

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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**