Eligibility Administrator

Imagine360 is currently seeking an Eligibility Administrator to join the team! This position maintains professional customer service for group plans, and works directly with assigned clients and Imagine360 departments regarding administrative and eligibility issues. The position is responsible for the daily support and processing of eligibility related functions for Imagine360 clients including determination of eligibility, participant data entry and record updates, COBRA administration and coordination of benefits. 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:

• Eligibility administration
  • Responsible for the timely, proficient and accurate processing of eligibility administration to ensure that regulatory requirements are met, clients are satisfied and retained and plans are administered in accordance with plan documents.
  • Reviews, processes, and maintains basic client and member enrollment data.
  • Processes terminations, COBRA notices and elections, plan changes and dependent changes
  • Process transactions "key from image" via electronic interface.
  • Ensure accurate and up to date information is reflected on the online member portal by maintaining client changes timely.
  • Prepares and balances billing statements.
  • Assists with ID Card requests
  • Ensures accurate data is entered into the applicable and appropriate system.
  • Prepares professional internal and external correspondence.
  • Supports other EBMS departments and staff in providing accurate eligibility information and data research.
  • Enter and maintain the appropriate coordination of benefits for members and dependents including double coverage and coordination with Medicare.
• Customer Service
  • Acts as a role model in demonstrating the core values in customer service delivery.
  • Provides timely and thorough follow up with internal and external customers.
  • Appropriately escalates difficult issues up the chain of command.
• Quality Assurance
  • Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters.
  • Performs self quality monitoring in order to develop and execute plans to meet established goals and requirements.
  • Completes peer quality reviews and provides appropriate feedback to the supervisor.
  • Provides ongoing feedback to help optimize quality performance.
  • Develops new or improves current internal processes to improve quality

Required Education/Experience:

• High School Diploma or equivalent
• Bachelor's degree preferred
• 1+ year medical or health insurance experience
• COBRA regulations and procedures experience preferred

Knowledge, Skills and Abilities:

• Working knowledge of computers and software including but not limited to Microsoft Office products; excel basic knowledge

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
• 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.

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