Location: State Wide
Company: Imagine360
strategies. Position Location: 100% remote Responsibilities include but are not limited to: Lead team consisting of claims adjusters, auditors, and administrators. Develop and maintain processes and guidelines for claim reviews. Provide expertise and guidance on complex and high cost claims.
Ensure nursing staff provides cost projection support as needed by underwriting. Regular review of open claims and actuary guidance to establish claim reserves. Audit and process claims as needed. Execute cost mitigation strategies to eliminate erroneous charges and deliver better care outcomes. Coach team members to ensure the successful execution of their role responsibilities and professional development.
Responsible for managing strategic relationships with stop loss vendors, clients, and brokers. Required Experience / Education: Bachelor's Degree in related field 8+ years of experience in medical claims administration, with at least 5 years administering claims at a third-party administration or stop loss/health insurance carrier.
Experience managing a team. Prior management experience preferred. Experience in health care provider billing is a plus. Highly developed knowledge and understanding of healthcare payers, health plan administration and medical service providers. Familiarity with ICD-10 and revenue codes. What can Imagine360 offer you? Multiple Health Plan Options, including
a 100% employer paid premiums option 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 Want to see our latest job opportunities?
Follow us on Linked In 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, interaction, interactionual 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.
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