Digital Resolution Specialist
About The Position
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.
Requirements
- High School Diploma or GED.
- Some college.
- 1+ year of healthcare related work experience.
- Customer service call center experience.
- Computer skills proficient in Microsoft Outlook, Word, Excel, and internet navigation.
Responsibilities
- 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
Benefits
- 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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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
