Digital Resolution Specialist

About the Role

Imagine360 invites applicants for the position of Digital Resolution Specialist, a remote-based role dedicated to providing clear and comprehensive responses to inquiries received via email or web portal from members, employers, and brokers. This role requires effective research, accurate documentation, prompt follow-ups, and timely resolution of requests while adhering to prescribed response times. Additionally, this position includes Plan Specialist responsibilities such as verifying member eligibility, outlining benefit descriptions, tracking claims status, conducting provider communication, educating on plans, ensuring HIPAA compliance, and managing complaint resolutions.

Key Responsibilities

• Address written queries from members, providers, and brokers using the web portal or departmental Outlook inboxes.
• Make outbound calls as required to support members or fulfill specific request obligations.
• Conduct in-depth research, document findings, and resolve all inquiries within established turnaround timeframes.
• Explain medical and dental benefits according to contract details.
• Provide claim updates, clarifying patient financial responsibilities, ineligible charges, and payments covered by the plan.
• Handle resolution of written complaints professionally.
• Offer information regarding Flexible Spending Accounts (FSAs), Health Savings Accounts (HSAs), and Health Reimbursement Accounts (HRAs).
• Support claimants with prescription drug plan inquiries.
• Collaborate with the claims department on claim review communications.
• Request stop pay actions and tracers as necessary.
• Coordinate appeal requests with the appropriate department.
• Assist collection teams in reconciling patient account issues.
• Ensure all interactions comply with Member Services Procedures, especially HIPAA guidelines and privacy rules.

Requirements and Qualifications

• Possess a High School Diploma or GED.
• Some college education preferred.
• At least one year of experience in healthcare-related roles.
• Call center customer service experience is essential.
• Proficient computer skills including Microsoft Outlook, Word, Excel, and web navigation.

Benefits and Perks

• Choice among multiple health insurance plans.
• Employer-paid premiums for disability and life insurance coverage.
• Parental leave benefits.
• Initial allocation of 20 paid time off days plus 10 paid holidays annually.
• Educational tuition reimbursement available.
• 401(k) plan with company contribution.
• Company-sponsored short and long-term disability and life insurance policies.
• Opportunities for professional growth and ongoing training.
• Participation in diversity and inclusion programs within the company.

Company Overview

Imagine360 is a health plan solutions provider with over five decades of expertise in self-funded healthcare. Having assisted thousands of employers reduce healthcare costs by billions, the company offers tailored, member-centered healthcare solutions that address the limitations of typical PPO insurance models.

Equal Opportunity Statement

Imagine360 is committed to equal employment opportunities without discrimination based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Additional Note for Recruitment Agencies

Only authorized agencies invited for this role may submit applications on behalf of candidates. Unsolicited resumes sent directly to hiring managers or without prior approval will not be eligible for fees.