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.
Imagine360
20 Remote Job Openings at Imagine360
The Lead Financial Analyst will develop advanced financial models and automated reporting solutions to support strategic decision-making. They will analyze claims volume trends and conduct variance analysis to provide actionable insights for leadership.
The specialist coordinates the tracking, documentation, and submission of stop loss claims to carriers for reimbursement. They also provide customer service to internal and external stakeholders and participate in quality assurance process improvements.
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 Claims Examiner is responsible for processing medical, dental, and vision claims by interpreting plan provisions for self-funded groups. They also handle customer inquiries, manage appeals, and collaborate cross-departmentally to improve quality and streamline procedures.
The RN is responsible for performing utilization reviews and medical necessity assessments for individuals under group health plans. They provide clinical oversight, coordinate treatment plans, and offer educational resources to members regarding diagnoses and treatments.
The Triage RN performs symptom triage and health assessments to guide members through their healthcare experience. They provide educational resources, resolve gaps in care, and ensure a smooth transition for new members into their health plan.
The Eligibility Administrator is responsible for processing enrollments, terminations, and changes for assigned client groups in a timely and accurate manner. This includes reviewing plan documents, managing qualifying events in COBRA systems, and coordinating with various departments to resolve eligibility issues.
Provide analytical and administrative support to the Client Experience team by preparing performance reviews and managing ad hoc reporting. Coordinate with internal and external experts to resolve issues related to claims, benefits determinations, and PBM prescription benefits.
Acts as the subject-matter expert for pharmacy-related inquiries and manages relationships with Prescription Benefit Manager (PBM) vendors. Responsibilities include implementing plan changes, auditing accuracy, and resolving member eligibility and drug coverage issues.
The analyst will leverage health insurance claim data to calculate potential savings for prospective clients and inform network strategies. They will also collaborate with brokers and sales representatives to provide data-backed fee recommendations and operational support.
The Vendor Manager is responsible for facilitating and maintaining relationships between Imagine360 and its vendor partners, serving as the primary point of contact for coordination and escalations. Key duties include managing vendor onboarding, monitoring performance metrics, and ensuring adherence to contractual service levels.
Support the development, modeling, and execution of health plan designs for self-funded employer groups. Partner with sales and implementation teams to create plan summaries, run savings comparisons, and manage benefit structures.
The specialist manages stop loss casework and provides tactical support to the Stop Loss Strategy Manager team to ensure pipeline efficiency. Responsibilities include coordinating communications, maintaining case files, and partnering with underwriting and sales stakeholders.
The role involves designing and executing multi-channel communication strategies to enhance member engagement with health plans. The manager acts as a strategic advisor to clients and internal teams to translate complex healthcare information into actionable content.
Manage strategic relationships with stop loss carriers and brokers to drive revenue growth and expand Risk Operations capabilities. Facilitate the solicitation and selection of stop loss insurance while serving as a subject matter expert for clients and internal stakeholders.
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.
The role involves managing enterprise resources through skill mapping, allocation, and capacity planning to ensure optimal utilization aligned with business goals. Additionally, the manager will champion Project Portfolio Management (PPM) tools and processes, developing dashboards to track strategic initiative milestones and overall portfolio progress.
