Imagine360 is currently seeking a Medical Claims Administrator to join our team! The Medical Claims Administrator coordinates the receipt, tracking, and documenting of stop loss claims submissions. Additional functions may include compiling reporting, communicating with third party administration staff, and processing claims. \n

Position Location: 100% remote \n

Responsibilities include but are not limited to:\n

Stop Loss Claims Management\n\nCompiles stop loss claim submissions and enters in claims system.\nLogs potential claim notices.\nEnsures all claim information is included in submission and follows up with third party administrator when necessary.\nProperly documents claim file.\nCompile periodic reporting for various stakeholders.\n\n

Claim Processing\n\nReview claims for appropriateness.\nApprove and facilitate funding with Finance.\n\n

Quality Assurance\n\nRecognizes, documents, and alerts appropriate supervisor of trends.\nPerforms self-quality monitoring in order to develop and execute plans to meet established goals.\nProvides ongoing feedback to help optimize quality performance.\nCollaborates with others and cross-departmentally to improve or streamline procedures.\nDevelops new or improves current internal processes to improve quality\n\n

Required Experience \/ Education:\n\nHigh School Diploma or GED required \nAssociates degree in Medical Billing and Coding or relative field preferred\n2+ years of experience in administration and customer service required\nUnderstanding of Medical Third Party Administration functions, Claims and Medical Terminology strongly preferred\nWorking knowledge of computers including but not limited to Microsoft Office products \nDemonstrated organizational skills, problem solving, analytical skills and detail orientated\n\n

What can Imagine360 offer you?\n\nMultiple Health Plan Options, including a 100% employer paid premiums option\n100% Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance\nParental Leave Policy\n20 days PTO to start \/ 10 Paid Holidays\nTuition reimbursement\n401k Company contribution\nProfessional development initiatives \/ continuous learning opportunities\nOpportunities to participate in and support the company's diversity and inclusion initiatives\n\n
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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.\n

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.\n

**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**\n