The Claims Examiner is responsible for processing medical, dental, and vision claims while interpreting plan documents and ensuring compliance with service standards. They also act as a point of contact for members and groups to resolve inquiries and provide timely customer service.
The Client Banking Specialist is responsible for collecting, processing, and distributing incoming and outgoing check payments for self-funded health plans. The role also involves performing quality assurance audits, tracking check runs, and providing support to the Client Banking Manager.
The Relationship Manager is responsible for overall client satisfaction, managing the onboarding process, and providing superior service to brokers and employers. They act as a liaison between internal staff and clients while identifying revenue opportunities and ensuring successful plan renewals.
The Reporting Analyst provides analytical and administrative support to the Client Experience Team by preparing performance reviews and monitoring portfolio trends. They are responsible for developing actionable insights from data and collaborating with Relationship Managers to implement client retention solutions.
The Claims Correspondence Review Specialist is responsible for reviewing and researching claims to determine eligibility while interpreting plan documents. They also provide timely customer service by resolving inquiries via email and phone for both internal and external stakeholders.
The Stop Loss Claims Specialist coordinates the tracking, monitoring, documenting, and submission of stop loss claims to carriers for reimbursement. They also manage large case notifications, resolve carrier inquiries, and maintain detailed internal records to ensure compliance and quality assurance.
The Analyst II performs advanced data analysis and develops data models to support business strategies and decision-making. They also manage data integrity, create visualizations, and provide mentorship to junior team members.
The Intake Specialist serves as the primary point of contact for members, managing initial file setups and balance bill inquiries. They are responsible for accurate data entry, coordinating with internal teams and third-party partners, and ensuring timely resolution of service issues.
The Senior Operations Specialist will lead end-to-end EDI implementation projects for new TPA partnerships, managing timelines and cross-functional coordination. They will also provide ongoing production support, monitor operational performance, and drive process improvements for transaction workflows.
The Member Services Advocate manages a caseload to provide advocacy, education, and case management for members navigating the balance bill defense process. They act as the primary point of contact to coordinate issue resolution between members, clients, legal teams, and medical providers.
The Care Coach provides telephonic coaching and educational resources to participants managing chronic health conditions. Responsibilities include assessing participant needs, coordinating care with health professionals, and documenting sessions in case tracking software.
The Client Reimbursement Advocate manages and negotiates medical claim disputes with providers to ensure fair agreements and access to care for members. They are responsible for maintaining the negotiation queue, documenting communications, and educating facilities on the company's billing processes.
Serve as the primary point of contact for members, providers, and pharmacies regarding prescription benefits, claims, and prior authorizations. Accurately document all interactions in internal systems while ensuring compliance with HIPAA and quality service standards.
Lead and manage the end-to-end delivery of PBM services for new and renewing clients. Coordinate with internal teams and stakeholders to ensure project milestones are met while managing risks and process documentation.
The Utilization Management RN performs clinical reviews to determine medical necessity and coordinates treatment plans for group health plan members. They also provide education to members and collaborate with physicians and healthcare professionals to ensure effective care delivery.
The Prescription (RX) Drug Implementation Coordinator manages end-to-end pharmacy setup requirements for new and existing clients. This includes coordinating with PBM partners, ensuring accurate file transmissions, and leading implementation activities for the Imagine360Rx solution.
The Growth Data Operations Manager oversees data workflows, governance, and quality to support sales and revenue operations. They manage CRM data, territory assignments, and AI-assisted workflows to drive revenue and ensure operational accuracy.
The Registered Nurse provides telephonic coaching and educational resources to participants managing chronic health conditions. Responsibilities include assessing participant needs, coordinating care with health professionals, and documenting activities in case tracking software.
The Dispute Resolution Specialist manages the research, strategy, and communication for Independent Dispute Resolution (IDR) matters. They are responsible for preparing arbitration packages, ensuring regulatory compliance, and coordinating across departments to achieve successful outcomes.
The Client Reimbursement Coordinator supports the advocacy team by managing intake communications, assigning referrals, and facilitating claims payments. They are also responsible for preparing reports, researching providers, and ensuring compliance with HIPAA regulations.
The Client Reimbursement Advocate manages and negotiates medical claim disputes with providers to ensure fair pricing and access to care for members. They act as a single point of contact for members, documenting all communications and identifying alternative provider options when necessary.
The specialist acts as a primary point of contact to educate providers and members on health plan benefits and secure necessary care. They also research member benefits, resolve cases, and assist advocates by documenting communications and identifying alternative provider options.
The Medical Claims Auditor reviews professional and facility claims for accuracy, compliance, and contractual adherence. They analyze medical records and itemized bills while applying standard coding rules and reimbursement methodologies.
The Dispute Selection Specialist handles No Surprises Act claims by researching eligibility and responding to Independent Dispute Resolution (IDR) notices. They also manage case closures, triage inquiries, and ensure compliance with HIPAA regulations.
The Supervisor, Case Management oversees a team of case managers, ensuring quality program initiatives, billing audits, and adherence to clinical policies. They also facilitate training, manage caseloads, and collaborate with leadership to improve service delivery and resolve member complaints.
The Benefit Review RN is responsible for performing utilization reviews and coordinating independent physician review requests for group health plan members. They will assess clinical data, facilitate treatment plan coordination, and provide patient education while adhering to internal policies and regulatory standards.
The Clinical Intake Specialist manages the notification process for medical services by utilizing electronic systems and following established policies. They provide non-clinical support, handle telephonic intake, and ensure accurate documentation in compliance with HIPAA and other regulatory standards.
The Upland Advocate manages a caseload of employees to help them navigate financial assistance programs, negotiate medical bills, and research discounted care options. They serve as a liaison between employees and providers while maintaining meticulous documentation and providing high-touch concierge support.
The Member Benefits Specialist acts as a primary point of contact for members, providing support and expertise regarding benefit plans and healthcare navigation. They are responsible for resolving member inquiries, conducting research, and ensuring accurate documentation while maintaining HIPAA compliance.
The associate will build relationships with clients and members to identify needs and facilitate innovative solutions for engagement. They will also serve as a member advocate, managing caseloads and coordinating issue resolution with internal and external stakeholders.
The Member Benefits Specialist acts as a primary point of contact for members, providing support and education regarding healthcare benefits and plans. They are responsible for resolving inquiries, conducting research, and maintaining accurate documentation while ensuring compliance with HIPAA regulations.
The associate will build relationships between clients, members, and stakeholders to drive engagement and success. They will also manage member caseloads and provide advocacy throughout the member journey to ensure timely issue resolution.
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.
