Imagine360

Manager, Benefit Configuration Quality and Audit

Imagine360 · Full Time · 3 hours ago

Imagine360

🌎 United States 💵 $100K - $120K per year ⭐ 10+ yrs exp 💼 Others

The Manager leads a team of offshore auditors to validate US healthcare plan configurations against approved documents and coding standards. They are responsible for driving audit consistency, defect prevention, quality metrics, and stakeholder communication across the Enterprise Quality Assurance organization.

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Manager, Healthcare Data Quality and Audit

Imagine360 · Full Time · 3 hours ago

Imagine360

🌎 United States 💵 $100K - $120K per year ⭐ 10+ yrs exp 💼 Data Entry

The Manager leads a team of onshore and offshore resources to oversee healthcare and pharmacy data quality, reconciliation, and audit controls. They are responsible for ensuring the integrity of EDI transactions and pharmacy claims while driving continuous improvement and vendor accountability.

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Sr. Director of Software Architecture and Development

Imagine360 · Full Time · a day ago

Imagine360

🌎 United States ⭐ 10+ yrs exp 💼 Software Development

The Sr. Director of Software Architecture and Development will define long-term technical strategy and oversee the delivery of mission-critical software solutions. They are responsible for scaling high-performing engineering teams and driving the modernization of legacy frameworks into microservices.

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Patient Advocacy Paralegal

Imagine360 · Full Time · a day ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Legal

The Patient Advocacy Paralegal acts as a liaison between legal, billing, and internal departments to manage balance bill and debt collection accounts. They collaborate with attorneys to develop case strategies and review medical billing documentation to support compliance efforts.

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Member Services Advocate - Bilingual Spanish

Imagine360 · Full Time · 2 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Support

The Billing Advocate manages assigned member caseloads by providing specialized case management, advocacy, and education regarding balance bill defense. They act as the primary point of contact for members, coordinating with internal teams and external stakeholders to ensure timely issue resolution.

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Stop Loss Nurse

Imagine360 · Full Time · 5 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Stop Loss Nurse identifies, monitors, and manages high-cost medical claims to ensure policy compliance and cost-effective care. They collaborate with internal teams, TPAs, and carriers to implement cost-containment strategies and provide accurate reporting on financial exposure.

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Supervisor, Implementation Coordination & Reporting

Imagine360 · Full Time · 5 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Supervisor will oversee TPA client new business and renewal implementations to ensure milestones align with readiness and production goals. They will also lead internal status discussions, manage cross-functional accountability, and identify opportunities to improve workflow efficiency using AI-enabled tools.

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Member Benefit Specialist

Imagine360 · Full Time · 6 days ago

Imagine360

🌎 United States 💵 $20 - $23 per hour ⭐ 2-5 yrs exp 💼 Others

The Member Benefit Specialist acts as a single point of contact for members, providing support and education regarding healthcare benefits and plans. Responsibilities include resolving inquiries, managing benefit administration, and ensuring accurate documentation while maintaining HIPAA compliance.

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Provider Data Management Specialist

Imagine360 · Full Time · 6 days ago

Imagine360

🌎 United States 💵 $40000 - $55000 per year ⭐ 2-5 yrs exp 💼 Data Entry

The Provider Data Management Specialist is responsible for the installation and ongoing maintenance of contracted provider data to ensure accuracy and integrity. They will investigate and resolve data discrepancies, coordinate with internal departments, and support provider education efforts.

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Invoice Fee Specialist

Imagine360 · Full Time · 8 days ago

Imagine360

🌎 United States 💵 $20.95 - $22.95 per hour ⭐ 2-5 yrs exp 💼 Others

The Invoice Fee Specialist is responsible for reviewing, validating, and processing Pharmacy Benefit Manager vendor invoices to ensure accuracy and contract compliance. They also identify billing discrepancies, reconcile costs, and coordinate with internal departments and vendors to resolve issues.

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Analyst I

Imagine360 · Full Time · 8 days ago

Imagine360

🌎 United States ⭐ 0-2 yrs exp 💼 Others

The Analyst I is responsible for collecting, analyzing, and interpreting data to support organizational decision-making. This role involves creating data visualizations and maintaining reports to track key performance indicators.

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Plan Document Technician

Imagine360 · Full Time · 8 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Plan Document Technician designs, builds, and maintains scalable SharePoint sites, workflows, and internal tools to support department operations. This role ensures technical infrastructure remains efficient and accurate while collaborating with stakeholders to translate business needs into practical solutions.

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Senior Operations Specialist

Imagine360 · Full Time · 8 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Senior Operations Specialist will lead end-to-end EDI implementation efforts for new TPA partnerships, managing timelines and cross-functional coordination. They will also serve as the primary operational owner for assigned accounts, monitoring performance and driving process improvements.

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Manager, Care Advocacy

Imagine360 · Full Time · 8 days ago

Imagine360

🌎 United States 💵 $75000 - $80000 per year ⭐ 5-10 yrs exp 💼 Others

The Manager, Care Advocacy oversees contact center service metrics, staff performance, and the development of member-centric strategies to ensure an elevated experience. They are responsible for coaching team members, driving operational efficiencies, and collaborating with leadership to analyze performance trends.

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Claims Internal Auditor

Imagine360 · Full Time · 12 days ago

Imagine360

🌎 United States 💵 $25 - $26 per hour ⭐ 2-5 yrs exp 💼 Finance

The role involves developing and executing audit plans to evaluate the effectiveness of operational processes, controls, and legal compliance. It also requires analyzing audit results to identify discrepancies and coordinating with external auditors to provide necessary data.

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Supervisor, Member Benefits

Imagine360 · Full Time · 12 days ago

Imagine360

🌎 United States 💵 $65000 - $70000 per year ⭐ 2-5 yrs exp 💼 Others

The Supervisor manages the Member Experience team by providing coaching, mentoring, and performance evaluations to ensure service excellence. They oversee contact center KPIs, handle escalated member issues, and coordinate daily work assignments to maintain productivity levels.

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Supervisor, Clinical Intake

Imagine360 · Full Time · 12 days ago

Imagine360

🌎 United States 💵 $65000 - $75000 per year ⭐ 2-5 yrs exp 💼 Healthcare

The Supervisor, Clinical Intake leads a team of Medical Intake Specialists by providing operational oversight, managing call queues, and conducting performance audits. They are responsible for developing training materials, implementing non-clinical policies, and ensuring HIPAA compliance across all intake activities.

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Billing Support Specialist

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States ⭐ 0-2 yrs exp 💼 Finance

The Billing Support Specialist provides specialized support and education to members of terminated accounts regarding the balance bill defense process. They coordinate issue resolution between members, medical providers, and legal teams to ensure a positive member experience.

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Disease Management Care Coach - Cardiology

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States 💵 $80000 - $85000 per year ⭐ 2-5 yrs exp 💼 Teaching

Provide telephonic coaching and educational resources to participants managing chronic health conditions, specifically in cardiology. Responsibilities include assessing participant needs, coordinating care with healthcare professionals, and documenting activities in case tracking software.

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Disease Management Care Coach - Pulmonology

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States 💵 $80000 - $85000 per year ⭐ 2-5 yrs exp 💼 Teaching

Provide telephonic coaching and educational resources to participants managing chronic health conditions, specifically in pulmonology. Responsibilities include assessing participant needs, coordinating care with healthcare professionals, and documenting activities in case tracking software.

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Triage RN

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Triage RN performs real-time symptom triage and health assessments to guide members through their healthcare experience and prevent gaps in care. They provide educational resources regarding medical diagnoses and refer members to appropriate Medical Management programs.

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Interdisciplinary Care Team, Behavioral Health, RN

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States 💵 $80000 - $85000 per year ⭐ 2-5 yrs exp 💼 Healthcare

Provide telephonic coaching and educational resources to participants managing chronic health conditions. Responsibilities include assessing participant needs, coordinating care with healthcare professionals, and documenting activities in case tracking software.

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Benefit Review RN

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Benefit Review RN is responsible for conducting utilization reviews and processing independent physician review requests for group health plans. This includes evaluating clinical data, coordinating treatment plans, and ensuring adherence to clinical guidelines and HIPAA regulations.

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Disease Management Care Coach - Bilingual

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States 💵 $80000 - $85000 per year ⭐ 2-5 yrs exp 💼 Teaching

Provide telephonic coaching and educational resources to participants managing chronic health conditions. Responsibilities include assessing participant needs, coordinating care with healthcare professionals, and documenting activities in case tracking software.

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Utilization Management RN

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The RN is responsible for performing utilization reviews and medical necessity assessments for group health plan members. This includes coordinating treatment plans, providing patient education, and ensuring compliance with HIPAA and URAC standards.

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Case Manager, RN

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The RN provides case management for group health plan members by performing clinical assessments and medical necessity reviews. They are responsible for coordinating medical services, providing member education, and documenting all processes in assigned software.

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Hematology/Oncology Case Manager, RN

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

The RN Case Manager coordinates care for hematology-oncology patients, focusing on medical necessity reviews and utilization management. They provide patient education and collaborate with community resources to ensure cost-effective and high-quality treatment outcomes.

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Oncology Case Manager, RN

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Oncology Case Manager RN coordinates inpatient and outpatient care for patients with oncology diagnoses, focusing on treatment sequencing and cost containment. Responsibilities include performing clinical assessments, managing complex disease cases, and providing educational resources to members and their support systems.

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Disease Management Care Coach

Imagine360 · Full Time · 13 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Teaching

Provide telephonic coaching and educational resources to participants managing chronic health conditions. Responsibilities include assessing participant needs, coordinating care with healthcare professionals, and documenting activities in case tracking software.

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Billing Specialist

Imagine360 · Full Time · 14 days ago

Imagine360

🌎 United States 💵 $25 - $26 per hour ⭐ 2-5 yrs exp 💼 Finance

The Billing Specialist is responsible for the accurate and timely generation of client premium billing and managing a portfolio of client groups. This includes performing billing audits, resolving discrepancies, and collaborating with internal teams to ensure invoice accuracy.

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New Business Specialist

Imagine360 · Full Time · 14 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Sales

The New Business Specialist coordinates the implementation and onboarding of new clients by configuring and validating eligibility data. They act as a central liaison between clients, brokers, and internal teams to ensure a seamless transition into production.

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Administrative Support Specialist

Imagine360 · Full Time · 14 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Support

The role is responsible for managing state and federal regulatory eligibility reporting, including vaccine assessments and CMS Section 111 filings. It also involves auditing EDI/834 files and supporting new business implementation to ensure data accuracy and compliance.

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Internal Auditor

Imagine360 · Full Time · 14 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Finance

The Internal Auditor reviews and evaluates the effectiveness of operations, processes, and controls to ensure legal compliance and efficiency. They provide objective recommendations for process improvements and coordinate with external auditors to manage data and reporting.

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Offshore Provider Relations Supervisor

Imagine360 · Full Time · 14 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Oversee day-to-day operations of offshore vendor partners to ensure provider inquiries are handled accurately and in compliance with SLAs. Monitor vendor performance, drive operational excellence, and collaborate with stakeholders to maintain high-quality service delivery.

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Claims Examiner

Imagine360 · Full Time · 14 days ago

Imagine360

🌎 United States 💵 $20 - $23.5 per hour ⭐ 0-2 yrs exp 💼 Legal

The Claims Examiner is responsible for processing medical, dental, and vision claims by applying plan provisions for self-funded groups. They also handle customer inquiries, manage appeals, and collaborate cross-departmentally to improve quality and streamline procedures.

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Billing Advocate

Imagine360 · Full Time · 14 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Finance

The Billing Advocate manages a member caseload to provide specialized advocacy and education regarding balance bill defense. They coordinate with legal teams, clients, and medical providers to ensure timely resolution of billing issues and a positive member experience.

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Eligibility Administrator

Imagine360 · Full Time · 14 days ago

Imagine360

🌎 United States 💵 $22 - $23 per hour ⭐ 2-5 yrs exp 💼 Software Development

The Eligibility Administrator manages member enrollment and eligibility transactions to ensure accurate benefits coverage for client groups. This includes processing enrollments, terminations, and changes while collaborating with clients and brokers to resolve discrepancies.

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Stop Loss Claims Auditor

Imagine360 · Full Time · 20 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Finance

The role involves auditing and processing stop loss claims, verifying benefit payments, and preparing written rationales for claim decisions. Additionally, the auditor manages claim reserves, handles customer inquiries, and ensures compliance with reporting requirements.

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Sr. Plan Document Specialist

Imagine360 · Full Time · 21 days ago

Imagine360

🌎 United States ⭐ 5-10 yrs exp 💼 Data Entry

Responsible for drafting, reviewing, and maintaining employee benefit plan documents and Summary Plan Descriptions for self-funded health plans. Ensures all documents comply with federal regulations like ERISA and ACA while collaborating with internal stakeholders and clients.

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Plan Analyst

Imagine360 · Full Time · 21 days ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Plan Analyst is responsible for constructing and implementing new plan documents within the claims system and ensuring system setups align with plan descriptions. They also interpret plan language for internal departments and resolve inquiries regarding plan design.

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Regional Sales Coordinator

Imagine360 · Full Time · a month ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Sales

The Regional Sales Coordinator provides administrative and coordination support to the Sales and Sales Operations Team, managing logistics and documentation. They act as a conduit between sales teams and the back office while liaising with external brokers to facilitate information exchange.

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Product Implementation Specialist

Imagine360 · Full Time · a month ago

Imagine360

🌎 United States 💵 $55000 - $60000 per year ⭐ 2-5 yrs exp 💼 Others

Maintain and update vendor grids, hierarchy documentation, and network routing information to ensure accuracy across the organization. Coordinate with cross-functional SMEs to support client implementations and communicate updates to downstream teams.

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Manager, Stop Loss Strategy

Imagine360 · Full Time · a month ago

Imagine360

🌎 United States ⭐ 5-10 yrs exp 💼 Others

Manage strategic relationships with stop loss carriers and brokers to drive revenue growth and expand Risk Operations capabilities. Facilitate the solicitation and evaluation of stop loss insurance while serving as a subject matter expert for clients and internal stakeholders.

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Invoice Fee Specialist

Imagine360 · Full Time · 2 months ago

Imagine360

🌎 United States 💵 $20 - $22 per hour ⭐ 2-5 yrs exp 💼 Others

The specialist is responsible for reviewing and validating PBM vendor invoices to ensure accuracy and compliance with contractual agreements. They reconcile billed fees against claims data and coordinate with vendors and internal managers to resolve billing discrepancies.

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Supervisor, Digital Resolution Team

Imagine360 · Full Time · 5 months ago

Imagine360

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Supervisor oversees escalated member issues and supervises staff managing written benefit-related inquiries, ensuring timely, accurate, and high-quality responses while maintaining service standards. This role involves providing daily guidance, coaching, quality oversight, and operational support to ensure team efficiency and adherence to service expectations.

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