Client Reimbursement Advocate

Imagine360 is currently seeking a Client Reimbursement Advocate to join our team! This 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 :

• Responsible for evaluating claims and contacting providers to negotiate single case agreements, determining the proper course of action to settle medical claims, monitoring and maintaining the negotiation queue and inventory, and working with internal and external partners to help resolve billing issues.
• Meet quality and production standards.
• Track and document all communications that relate to the claims and settlement negotiations.
• 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.
• Adhere to guidelines, escalate claims 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.

Education and Experience :

Required Education : High School Diploma or GED ( Bachelor's degree preferred)

Required Experience : Minimum 1 year of healthcare, health insurance, or customer service experience

Skills and Abilities :

What can Imagine360 offer you?

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I magine360 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.