Plan Design Specialist

Imagine360

22h•Remote

About The Position

Imagine360 is seeking a Plan Design Specialist to join their team. This position is responsible for constructing and implementing new plan documents in the claims system and maintaining a comprehensive understanding of the plan documents under their scope of responsibility. Imagine360 is a health plan solution company with over 50 years of self-funding healthcare expertise, helping employers save billions on healthcare with customized, member-focused solutions.

Requirements

High School Diploma or equivalent
3+ years of Claims Examiner and/or plan building experience
Familiarity with GBAS system
Demonstrated organizational skills, problem-solving, analytical skills and detail oriented
Strong written and oral communication skills
Working knowledge of computers and software including but not limited to Microsoft Office products
Demonstrated ability to work independently, prioritize workloads, multi-task and manage priorities in order to meet deadlines
Proficient 10-key and typing skills

Responsibilities

Designs and implements system set up in accordance to plan document description.
Builds new groups and adjusts system per plan amendments in Claims system.
Documents applicable changes in related systems.
Determines benefits using ICD, CPT, HCP and Rev Codes in association with provider specialty, age, relationship, place of service and PPOs.
Updates accumulators for newly implemented groups.
Ensures plan language conforms to the group's intent.
Interprets and explains plan document language and plan designs for various EBMS departments.
Receives and resolves internal inquiries regarding plan document language and design.
Provides timely and thorough follow up with, internal and external customers.
Appropriately escalates difficult issues up the chain of command.
Acts as a role model in demonstrating the core values in customer service delivery.
Trains and mentors new employees as assigned.
Attends and participates in committee meetings and training sessions.
Performs self-quality monitoring in order to develop and execute plans to meet established goals.
Provides ongoing feedback to help optimize quality performance.
Collaborates with staff and cross-departmentally to improve or streamline procedures.
Assists the Claim Department in performing plan design testing for new clients and renewing clients to assure quality output from the system.

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