Plan Design Specialist

Imagine
360 is seeking a Plan Design Specialist to join the team! This position constructs and implements new plan documents in the claims system. This position maintains a comprehensive understanding of the plan document(s) under their scope of responsibility.

100% remote

• Plan building
  • 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.
• Plan Document Language
  • Ensures plan language conforms to the group's intent.
  • Interprets and explains plan document language and plan designs for various EBMS departments.
• Customer Service
  • 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.
• Quality Assurance
  • 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.

• 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

• 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

Imagine
360 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.