Claims Correspondence Review Specialist

Imagine360 is currently seeking a Claims Correspondence Review Specialist! This role supports TPA Ops by assisting with questions and resolving issues related to claims. The position performs research to accurately respond to inquiries and supports timely claim processing by maintaining a comprehensive understanding of the plan document(s) under their scope of responsibility.

Position Location: 100% remote

Responsibilities include but are not limited to:

Claims Review

• Understand and review claims processing.
• Interpret plan documents.
• Review, research, and analyze information to determine eligibility.
• Perform outbound telephone calls to assist in obtaining the required information to process a claim.

Work with the Claims Examiner to resolve claims processing issues.

Operational Support

• Receive, review, and respond to inquiries regarding plan documents, benefits, and claims.
• Review and respond to emails in a timely manner.
• Manage emails in shared mailboxes and group-specific mailboxes and provide acknowledgement and resolution to email questions within 8 hours or provide the customer with an ETA and explanation for delay.
• Review and respond to Freshdesk tickets in a timely manner.
• Respond to and resolve urgent issues in a timely manner.
• Regularly check and prioritize voicemails on an hourly basis and reply in a timely manner, no more than 8 hours.
• Act as a role model in demonstrating the core values in customer service delivery.
• Provide timely and thorough follow up with internal customers and appropriate parties.
• Track and return telephone calls/mail to members and groups answering specific plan or claim questions within 24 hours.
• Appropriately escalate difficult issues up the chain of command.

Quality Assurance

• Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
• Collaborates with others and cross-departmentally to improve or streamline procedures.
• Performs self-quality monitoring to develop and execute plans to meet established goals.

This job description in no way states or implies that these are the only duties to be performed by this employee. The employee will be required to follow any other instructions and to perform any other duties requested by his/her supervisor.

Required Education:

• High school diploma or equivalent

Required Experience:

• Two years of claims examiner and/or customer service experience
• Proficient 10-key and typing skills
• Working knowledge of computers and software including but not limited to Microsoft Office products
• Demonstrated organizational skills, problem-solving skills, analytical skills, and attention to detail
• Strong written, oral, and telephonic communication skills with attention to detail and accuracy
• Demonstrated ability to work independently, prioritize workloads, and multi-task
• Demonstrated ability to work in a fast-paced environment while maintaining accuracy and production requirements
• Demonstrated ability to remain neutral and maintain confidentiality

Physical Requirements:

Work is indoors in an office environment with moderate noise. Intermittent physical effort involving lifting of up to 25 pounds, walking, and stooping, kneeling, crouching, or crawling is required. A typical workday involves sitting, frequent use of a keyboard, reaching with hands and arms, and talking and hearing, approximately 70% of the time. Approximately 30% or less of the time is spent standing. Normal vision abilities required, including close vision and ability to adjust focus.

What can Imagine360 offer you?

• Multiple Health Plan Options, including a 100% Employer Paid Benefit Options
• 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

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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, sex, sexual 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. Thank you for your cooperation**