Member Benefit Specialist

Imagine360•,

2d•Remote

About The Position

Imagine360 is seeking a Member Services Professional (Navigator) to join the team! In this role you will provide end-to-end support for members by answering inbound inquiries and proactively guiding them through their healthcare journey. You will serve as a single point of contact to explain benefits, help locate and schedule care, support claim and billing questions, and coordinate with internal and external partners to remove barriers to care. By educating members on available resources and advocating on their behalf, you will help members navigate the complexities and costs of healthcare with confidence.

Requirements

High school diploma or GED required
1+ year healthcare industry experience in a member-facing, patient advocacy, care navigation, or benefits-focused role
1+ year experience delivering customer/member-focused solutions and education in a call center, virtual/telephonic, or in-person environment
Proficient in Microsoft Outlook, Word, and Excel
Service-driven, member-first mindset with strong empathy and professionalism
Strong verbal and written communication skills with the ability to explain complex benefit concepts clearly
Ability to assess needs, problem-solve, and coordinate next steps across multiple partners to achieve resolution
Aptitude for learning and retaining detailed plan and process information
Comfortable documenting in multiple systems while maintaining accuracy, confidentiality, and HIPAA compliance

Nice To Haves

associate or bachelor's degree preferred
Experience verifying medical benefits and/or supporting benefit inquiries
2+ years healthcare experience (carrier, TPA, patient advocate, or other benefits-focused role)
Medical claims exposure (ICD-9/10, CPT, claim forms)

Responsibilities

Deliver above-and-beyond service across multiple channels (phone, email, portal) while maintaining ownership of each member issue through resolution
Act as a dedicated member navigator and advocate, guiding members to the right resources, next steps, and cost-conscious care options
Explain health benefit coverage, including accumulators, explanation of benefits (EOBs), out-of-pocket maximums, reimbursement levels, and eligibility
Become an expert in benefit administration, FSAs, HSAs, HRAs, and alternative benefit payment designs (including reference-based pricing)
Support members with provider research, appointment scheduling, and medical record retrieval; coordinate next steps to reduce handoffs and delays
Assist with claims and billing questions by researching issues, clarifying what is needed, and coordinating with internal teams and external partners as appropriate
Educate members on pre-service and post-service steps to optimize their healthcare experience, including how to prepare for care and what to expect after services
Anticipate member needs, conduct research on their behalf, and follow up to confirm understanding and completion of next steps
Resolve member complaints and escalate complex issues appropriately while keeping the member informed throughout the process
Collaborate with internal and external partners to ensure best-in-class service delivery and timely resolution
Treat all calls and correspondence using established procedures, including strict adherence to HIPAA guidelines and HIPAA Privacy Rules
Document interactions accurately in appropriate software (e.g., Collybus, Javelina, GBAS) and maintain thorough case notes to support continuity of care

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