The representative is responsible for processing incoming tasks, updating member demographics, and managing the support inbox. They also handle the filing of regulatory documents and distribute payment details to billing specialists.
Imagine360
27 Remote Job Openings at Imagine360
The role supports underwriting by managing RFP submissions, setting up case files, and communicating with external parties. It also involves facilitating the binding and policy issuance processes for insurance groups.
Manage enterprise resource allocation and capacity planning to align with business goals. Champion Project Portfolio Management (PPM) tools and develop performance dashboards to track strategic initiatives.
The specialist provides non-clinical administrative support to the Medical Management team, including case assignment and documentation requests. They are responsible for managing department email inboxes, processing participant assessments, and ensuring HIPAA compliance.
The Care Access Guide researches provider accessibility and coordinates medical services for members who did not achieve first call resolution. Responsibilities include negotiating with out-of-network providers, retrieving medical records, and documenting all actions in proprietary software.
The specialist handles written inquiries from members, employers, and brokers via email and web portals to resolve issues regarding benefits and claims. Responsibilities include researching eligibility, explaining financial responsibilities, and ensuring HIPAA compliance.
The Clinical Intake Specialist manages the notification process by entering clinical data and coordinating with providers in compliance with medical management policies. They provide non-clinical support and handle telephonic intake queues to ensure accurate documentation of medical services.
Act as a single point of contact for members to resolve inquiries regarding benefit plans and healthcare navigation. Responsibilities include educating members on FSAs, HSAs, and HRAs while ensuring compliance with HIPAA guidelines.
Responsible for compiling, reconciling, and posting financial data to maintain client records and produce financial reports. Duties include processing checks and ACH transactions, monitoring accounts receivable, and performing quality audits of financial work.
The Billing Advocate manages a caseload of members to guide them through the balance bill defense process. They coordinate with legal teams, medical providers, and clients to resolve billing issues and ensure a positive member experience.
The role supports the development, modeling, and execution of health plan designs for self-funded employer groups. It involves partnering with sales and implementation teams to create plan summaries, run savings scenarios, and maintain process documentation.
Support EDI implementations and post-implementation production for 834 and 837 transactions with third-party administrators. Act as the primary operational liaison to ensure smooth onboarding, resolve processing discrepancies, and maintain detailed SOPs.
The role involves assisting Conduent Staff with inquiries about plan language, benefits, and claims while accurately recording interactions. Additionally, the position requires providing support for escalated calls and delivering real-time coaching to ensure provider satisfaction.
The Supervisor, Provider Benefits will lead day-to-day team performance and oversee service delivery while ensuring accurate documentation of customer interactions. They will also support operational oversight of the leads and Assist Line support team, monitoring service quality and issue resolution.
Manage a portfolio of clients and brokers to ensure satisfaction, retention, and growth through effective communication and program analytics. Act as a liaison between internal staff, clients, and vendors to oversee the administration of healthcare benefit plans.
The Manager of Sales Engineering supports the strategy and execution of sales enablement initiatives to remove friction from the sales process. This role acts as a cross-functional partner to ensure the sales field has the necessary tools, knowledge, and processes to improve commercial effectiveness.
The role involves analyzing financial data and risk factors to determine rates and manage a book of renewing and new business accounts. It also requires collaborating with staff and customers to ensure underwriting policies are followed and organizational growth is achieved.
The Oncology Case Manager RN coordinates inpatient and outpatient care for patients with oncology diagnoses, focusing on treatment sequencing and cost containment. They perform clinical assessments, manage complex disease cases, and provide educational resources to members and their support systems.
Lead the implementation process for new TPA groups by coordinating between clients, brokers, and internal departments. Manage documentation, eligibility verification, and the setup of plan administration and external vendors.
Provide telephonic coaching and educational resources to participants with chronic health conditions, focusing on nutrition, medication compliance, and physical activity. Perform clinical nutrition assessments, develop individualized care plans, and coordinate with healthcare professionals to manage patient outcomes.
The Director is responsible for executing underwriting and risk strategies and directing staff to generate compliant quotes. They also serve as a subject matter expert for sales and other departments to optimize cost containment solutions.
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.
The Project Manager is responsible for directing key projects supporting PBM operations, including creating project plans and leading cross-functional teams. They will manage the full project lifecycle from discovery and business requirement gathering to execution and quality assurance.
Leads the onboarding and implementation process for reference-based pricing clients, including system setup and plan changes. Manages the preparation, execution, and maintenance of administrative service agreements and coordinates with third-party administrators and brokers.
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.
The Project Manager will manage and direct key healthcare payer enterprise projects, including defining requirements and creating project plans. They will lead cross-functional teams to ensure successful project delivery while managing interdependencies between business operations and technology.
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.
