Member Benefit Specialist
About The Position
Imagine360 is seeking a Member Benefit 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, guiding them throughout their healthcare experience. By educating members on resources and benefits available to them, the Member Services Professional plays a key role in the member's journey navigating the complexities and cost of healthcare. 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.
Requirements
- High school diploma or GED.
- 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.
- 2+ years healthcare experience i.e. carrier, TPA, patient advocate, or other benefits focused role.
- Medical claims exposure (ICD-9/10 coding, CPT coding, and medical claim forms).
- 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
Responsibilities
- 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) and alternative benefit payment designs specifically reference based pricing
- Guide understanding of health benefit coverage including accumulators, explanation of benefits, out of pocket maximums, and reimbursement levels
- 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, including CaseTrakker, Macess, etc.
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
High school or GED
