Member Benefits Specialist - Member Services Professional - MST Time Zone

Imagine360 is seeking a Member Benefits Specialist to join the team!  In this position you will be receiving inbound calls from members, to help with inquiries involving benefit plans. You will act as an advocate for members by providing knowledge, expertise, and support to members and providers, guiding them throughout their healthcare experience. By educating members on resources and benefits available to them, the Member Benefits Specialist plays a key role in the member's journey navigating the complexities and cost of healthcare.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Deliver above and beyond service over multiple channels including phone, email, portal inquiries, etc. by acting as a single point of contact, maintaining ownership of member resolution

• Become an expert in benefit administration, Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Level Funded plans, minimal essential coverage plans and alternative benefit payment designs specifically reference based pricing

• Guide understanding of health benefit coverage including accumulators, explanation of benefits, out of pocket maximums, reimbursement levels, and federal regulations such as NSA and ACA.

• Take ownership of the member experience from beginning to end, reducing handoffs to others to ensure consistency and resolution

• Anticipate the needs of members and conduct research on members' behalf to resolve issues

• Educate members on pre and post services in conjunction with benefit to optimize the member experience throughout their healthcare journey

• Collaborate with internal and external partners to ensure a best-in-class service delivery

• Resolve member complaints

• Treat all calls and correspondence using procedures and paying attention to the sections relating to HIPAA guidelines and the HIPAA Privacy Rules

• Complete provider research, appointment scheduling, medical record retrieval and all other non-clinical duties assigned within applicable timeframes in compliance with Policy & Procedures

• Accurate documentation in appropriate software

Required Experience/Education:

• High school diploma or GED

• Bachelor's degree preferred

• 1+ year healthcare industry work experience.

• Experience in delivering client-focused solutions based on customer needs within direct member contact and education.

• Ideally virtual/telephonic, in-person experience with the public.

• 1+ year with telephonic verification of medical benefits preferred

• 2+ years healthcare experience i.e. carrier, TPA, patient advocate, or other benefits focused role preferred

• Medical claims exposure (ICD-9/10 coding, CPT coding, and medical claim forms) preferred.

Skills and Abilities:

• Proficient in Microsoft Outlook, Word and Excel

• Service-driven mindset

• Aptitude for learning and retention

• Advanced soft skills with a high level of emotional intelligence

• Strong written communication skills

What can Imagine360 offer you?

• Multiple Health plan options