Claims Support Specialist Team Lead

Imagine360 is seeking a Claims Support Specialist Team Lead to join the team! The Claims Support Lead supports the Manager and provides day-to-day assistance to the Claims Support Specialists. This role services as a resource for claims and benefit questions, procedural guidance, issue resolution, quality awareness, and workflow support to help ensure inquiries are responded to timely in accordance with turnaround expectations. This position serves as the primary point of contact for internal staff inquiries and performs research to accurately respond to inquiries from internal customers. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Identify workflow concerns, recurring questions, or processing issues and escalate them to the Claims Manager as appropriate.
• Provides timely and thorough follow-up with staff, internal and external customers.
• Ability to communicate effectively with all levels of employees and demonstrate empathy and practice active listening
• Maintain a working knowledge of all regulatory and compliance guidelines that affect the scope of the department.
• Research claim status, payment details, denials, and adjudication issues to provide accurate and timely responses.
• Interpret plan documents, benefits, coordination of benefits (COB), and processing guidelines to resolve inquiries.
• Collaborate with Claims, Eligibility, Provider Maintenance, Customer Service, and other departments to gather information and resolve issues.
• Document all inquiries, responses, and outcomes in the appropriate tracking system for reference and reporting.
• Identify recurring issues or trends and escalate to management for process improvement opportunities.
• Participate in team meetings and provide feedback to enhance claims inquiry handling processes.

Required Experience/Education:

• High school diploma or equivalent

Preferred experience:

• Experience in health insurance claims administration or related field.

Skills and Abilities:

• Working knowledge of computers and software including but not limited to Microsoft Office products.
• Demonstrated organizational, problem solving, and analytical skills as well as detail oriented.
• Strong written, telephonic, and oral communication skills
• Demonstrated ability to work independently, prioritize workloads, multi-task and manage priorities to meet deadlines.

What can Imagine360 offer you?

• Multiple Health plan options
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Company paid Short & Long term Disability plus Life Insurance
• Parental Leave Policy
• 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**