Manager, Medical claims data specialist

Imagine360 is currently seeking a Manager, medical claims data specialist to join the team! The Manager, medical claims data Specialist, is responsible for leading the teams managing the reporting process within Risk Operations. The role will also be responsible for auditing team members on quality of production. Additional functions may include compiling reporting and communicating with third party administration staff.

Position Location: 100% Remote

Responsibilities include but are not limited to:

Supervisory Responsibilities:

• Claims Data Specialist
• Team Lead, Claims Data Specialist
  
  
  

Leadership

• Manages the day-to-day tasks and goals of the claims team
• Manages the team performance, gives direction, feedback, and coaching to employees on day-to-day tasks and overall career progression and development
• Manages and approves the team's workload, schedules, PTO requests, etc.
• Leads special projects as needed
  
  
  

Stop Loss Claims Management:

• Responsible for the timely and accurate entry of claims data.
• Analyze data across various departments to solve business problems, create value and efficiency and find opportunities.
• Compile, analyze and interpret data with guidance from various stakeholders.
• Prepare analytical reports and develop data visualizations using best practices adhering to internal standards. Present findings to stakeholders and/or clients directly as needed.
• Evaluate options and make recommendations to business processes to gain efficiency and enhance performance related to data.
• Use analysis techniques to support design, development, and maintenance of user-friendly and efficient business and data processes.
• Perform project management for data entry and analysis projects.
• Solve complex problems and present solutions to senior leaders.
• Contribute to development of new analytical processes to optimize the business.
• Collaborate extensively with Risk Operations leaders to ensure successful projects and optimized use of data and resources.
• Participation in other projects and duties as assigned.
  
  
  

Claims Support:

• Compile periodic reporting for internal and external parties
• Advise on claim projections and development
  
  
  

Quality Assurance

• Recognize, document, and alert appropriate supervisor of trends in claims
• Performs self-quality monitoring to develop and execute plans to meet established goals
• Meet established turnaround time and accuracy metrics
• Provides ongoing feedback to help optimize quality performance
• Collaborates with others and cross-departmentally to improve or streamline procedures
  
  
  

Education:

• Bachelors degree in Medical Billing and Coding or related field preferred
  
  
  

Experience:

• Experience leading and managing a team
• 8+ years' experience in medical claims administration (carrier or provider)
• Understanding of medical Third-Party Administration functions preferred
• Knowledge of medical terminology required
• Working knowledge of computers and software including but not limited to Microsoft Office products
• Demonstrated organizational skills, problem-solving, analytical skills and detail oriented
  
  
  

What can Imagine360 offer you?

• Multiple Health Plan Options, including a 100% Employer Paid Benefit Options
• 100% Company paid employee premiums for Dental, Vision, STA, & LTD, plus Life Insurance
• Parental Leave Policy
• 20 days PTO to start / 10 Paid Holidays
• Tuition reimbursement
• 401k Company contribution
• Professional development initiatives / continuous learning opportunities
• Opportunities to participate in and support the company's diversity and inclusion initiatives
  
  
  

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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.

**RECRUITMENT AGENCIES PLEASE NOTE: Imagine360 will only accept applications from agencies/business partners that have been invited to work on a specific role. Candidate Resumes/CV's submitted without permission or directly to Hiring Managers will be considered unsolicited and no fee will be payable. Thank you for your cooperation**