Client Reimbursement Advocate - Pre Service

Imagine360 is seeking a Client Reimbursement Advocate - PreService to join the team! On behalf of clients and members, the Client Reimbursement Advocate works directly with providers to manage, negotiate, and resolve disputes to ensure fair and reasonable agreements on medical claims and services and to secure access to care for members. As the Client Reimbursement Advocate, your empathetic nature is essential as you advocate for members to minimize provider balance billing and denials of care.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Deliver specialized service over multiple channels by acting as a single point of contact, maintaining ownership of member resolution and navigating optimal care.
• Manage and coordinate elevated member issue resolution with confidence and a sense of urgency.
• Responsible for contacting providers to negotiate single case agreements, monitoring and maintaining their assignment queue, and working with internal and external partners to help member access to care issues.
• While meeting quality and production standards, you track and document all communications and efforts on assigned matters. In addition, you contact providers to resolve access to care issues and to explain medical plan pricing metrics.
• When resolution cannot be secured with the provider, you assist members with identifying alternative provider options.
• In order to build sustainable relationships and trust with clients, you adhere to guidelines, escalate challenges for management review when needed, and maintain open and interactive communication with all key players. With your exceptional customer service skills, you identify and execute on opportunities to negotiate settlements with providers, contact facilities upon request to educate them regarding the i360 process, and champion on behalf of the member to ensure fair access to care at reasonable cost.

Required Experience/Education:

• Bachelor's degree preferred
• Minimum 1 year of healthcare, health insurance, or customer service experience

Skills and Abilities:

• Excellent communication (written, verbal, and listening), interpersonal, and analytic skills
• Experience with negotiations preferred
• Knowledge and understanding of CMS1500 and UB04 Medical Claim Forms, medical coding, and proficiency in Microsoft Office products desired
• Experience in billing, insurance, healthcare, or legal environments is a plus!

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**