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Imagine360 is currently seeking a Dispute Resolution Specialist to join the team! The Dispute Resolution Specialist will be the primary party responsible for research, strategy, communication, and all other matters related to Independent Dispute Resolution ("IDR"). The incumbent will coordinate efforts with the team and leadership to bring matters to efficient and successful outcomes. The Dispute Resolution Specialist will oversee the intake, processing and coordination of all materials and information as regulated by Federal or state law.
Position Location: 100% remote
Responsibilities include but are not limited to:
- Prepare written analyses of disputed health plan positions and persuasively document arguments supporting client positions in arbitration packages pursuant to federal regulations.
- Conduct due diligence to assist with the analysis and preparation of arbitration packages.
- Work with other departments to develop or obtain information necessary for the submission of IDR packages.
- Review and analyze clinical information along with documents submitted by providers of moderate to high complexity.
- Meet federal filing deadlines and turnaround times.
- Maintain detailed and accurate records.
- Maintain department productivity and quality standards.
- Collaborate, coordinate, and communicate across disciplines and departments.
- Ensure compliance with HIPAA regulations and requirements.
- Any other duties or responsibilities related to IDR that may be otherwise required or assigned as necessary.
Required Experience / Education:
- Minimum 1 year of experience in healthcare operations relating to the No Surprises Act or Independent Dispute Resolution.
- Excellent organizational, analytical and independent decision-making skills.
- Demonstrated problem solving skills with the ability to manage multiple priorities and meet associated timelines.
- Ability to anticipate needs and solve problems proactively in a fast paced, rapidly changing environment.
- Sound business judgement.
- Ability to learn quickly and work independently within time constraints.
- Adept knowledge of Microsoft Word, Excel and Outlook.
- Logical, clear and concise written and verbal communication skills.
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**
