Appeals Review Specialist (Healthcare Claims)

Imagine360 is currently seeking an Appeals Review Specialist to join our team! The Appeals Review Specialist is responsible for the review of claims from providers for possible errors to ensure plan assets are protected. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility

Position : 100% Remote

Responsibilities include but are not limited to :

• Claim edits and reviews

Verifies claim accuracy compared to medical record.

Reviews, researches, and responds to members and providers in writing regarding questions, complaints or denied coverage objections.

Acts as a role model in demonstrating the core values in customer service delivery.

Sends letters to providers and members explaining a denial.

Serves on committees, work groups, and / or process improvement teams, as assigned, to assist in improving quality / customer satisfaction.

Maintains regulatory compliance standards

This job description in no way states or implies that these are the only duties to be performed by this employee. The employee will be required to follow any other instructions and to perform any other duties requested by his / her supervisor .

Education and Experience :

Skills and Abilities :

What can Imagine360 offer you?

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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.