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 orienta