Imagine360

This role primarily involves providing written responses to inbound inquiries from members, employers, and brokers via email or web portal, focusing on research, documentation, follow-ups, and timely resolution. Core duties also include functions similar to a Plan Specialist, such as explaining benefits, checking claim status, and resolving complaints.

The specialist will handle inbound calls from members regarding benefit plan inquiries, acting as a single point of contact to deliver service across multiple channels and maintain ownership of member resolution. Key duties include becoming an expert in benefit administration (FSA, HSA, HRA), guiding members on coverage details, and resolving issues through research and collaboration.

The Manager, Medical Claims, leads the end-to-end process for preparing, validating, and submitting stop-loss claims to ensure accurate and timely reimbursement for high-cost medical claims. This involves overseeing daily team operations, establishing quality standards, and collaborating internally and externally to optimize outcomes and drive continuous improvement.

The coordinator manages the end-to-end pharmacy setup requirements for new and existing clients, which involves coordinating with Pharmacy Benefit Manager (PBM) partners and internal teams. Key duties include leading implementation activities for the Imagine360Rx solution, acting as the subject-matter expert for client pharmacy benefits, and ensuring accurate setup of required files and documentation.

This role is responsible for maintaining current and new provider and PPO information while ensuring the accuracy of claim repricing processes. Key duties include maintaining turnaround times, communicating professionally with vendors, researching repricing appeals, and accurately repricing claims in a timely manner.

The Medical Auditor is responsible for auditing medical facilities and professional claims for accuracy and compliance with industry laws and contractual language on behalf of our clients. Review medical facility and professional claims for accuracy and apply standard coding rule...

Imagine360 is seeking a Utilization Management, RN to join the team! The RN Utilization Management Nurse is responsible for providing utilization review/notifications and education for individuals under the group health plans administered by imagine360 by utilizing nursing educat...

The Manager, Medical Claims, is responsible for leading the end‑to‑end process of preparing, validating, and submitting stop‑loss claims to ensure timely and accurate reimbursement for high‑cost medical claims. This role oversees daily team operations, establishes workflow and qu...