Digital Resolution Specialist

Imagine360 is seeking a Digital Resolution Specialist to join the team!  This position functions primarily in a written capacity to provide meaningful responses to inbound member, employer, and/or broker e-mail or web portal requests. The Digital Resolution Specialist is responsible for research, documentation, follow-ups, and resolution while adhering to appropriate turnaround times. In addition, this position encompasses the core functions of a Plan Specialist including but not limited to providing member eligibility, descriptions of benefits, claims status, provider outreach, plan education, HIPAA compliance, and resolving complaints.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Respond to written inquiries from members, providers, and brokers via the web portal or departmental Outlook email addresses
• Outbound calling, as needed, to provide further member support or meet the requirements of the request
• Research, document, and resolve all inquiries within outlined turnaround times
• Describe medical and dental benefits according to group contracts
• Provide claim status, including the accurate explanation of patient financial responsibility, ineligible amounts, and plan payments
• Resolve written complaints
• Provide information to employees' regarding their Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), and Health Reimbursement Accounts (HRAs)
• Assist claimants with prescription drug plan program
• Coordinate claim review information with the claims department
• Request stop pays/ tracers
• Receive and coordinate appeal requests with appropriate parties
• Assist collectors in reconciling patient accounts
• Treat all calls and correspondence using the Member Services Procedures, paying attention to the sections relating to HIPAA guidelines and the HIPAA Privacy Rules
  
  
  

Required Experience/Education:

• High School Diploma or GED.
• Some college.
• 1+ year of healthcare related work experience.
• Customer service call center experience.
  
  
  

Skills and Abilities:

• Computer skills proficient in Microsoft Outlook, Word, Excel, and internet navigation.
  
  
  

What can Imagine360 offer you?

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