Imagenet LLC

• Lead quality assurance and training programs supporting healthcare operations. • Develop and maintain standardized onboarding and certification programs for claims and/or contact center teams. • Conduct QA audits, side‑by‑side coaching, and training sessions to improve operational performance. • Support underperforming teams through targeted training and QA interventions. • Establish and maintain QA scorecards and ensure consistent scoring standards. • Participate in internal and client-facing calibration sessions to align quality expectations. • Analyze QA trends and identify root causes for errors, performance gaps, and training needs. • Partner with Operations leaders to implement improvement initiatives. • Track and report QA performance, training completion, and certification results. • Ensure training and QA processes comply with HIPAA and client-specific requirements.

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies. • Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing. • Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues. • Participate in ongoing training and professional development activities. • Maintain accurate and detailed records of claims processing activities. • Review claim forms and supporting documents • Determine eligibility, verify data accuracy • Request additional information when needed • Process claims end-to-end • Identify and escalate complex or unusual claims for further review or investigation.

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies • Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing • Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues • Participate in ongoing training and professional development activities • Maintain accurate and detailed records of claims processing activities • Review claim forms and supporting documents • Determine eligibility, verify data accuracy • Request additional information when needed • Process claims end-to-end • Identify and escalate complex or unusual claims for further review or investigation • Participate in ongoing training and professional development activities • Handle more complex claims with multiple services, providers

• Provide day-to-day operational leadership for the Philippines-based adjudication team (examiners, auditors, and team leads), working across time zones to direct priorities and remove blockers. • Serve as the hands-on claims SME for the campaign — personally adjudicating complex or escalated claims and modeling correct handling for the team. • Drive accuracy, productivity, quality, and service-level goals; translate client requirements into clear, executable operating procedures. • Partner with the offshore manager and team leads to strengthen communication, information flow, and consistency of execution. • Act as the senior operational single point of contact (SPOC) for the client, consolidating guidance from multiple client stakeholders into one consistent set of directives for the delivery team. • Lead client working sessions, escalations, and operational updates with confidence and credibility; provide clear written and verbal updates on performance, quality, and improvement actions. • Manage frequently changing client requirements — capturing, sequencing, and operationalizing new directives without disrupting production. • Own the quality program: reduce repeat errors, identify root causes, and close coaching gaps through targeted, SME-led feedback. • Align coaching responsibilities with subject-matter expertise; design and lead calibration sessions between examiners and auditors. • Oversee validation of production reporting; partner with the business analyst and client to resolve reporting discrepancies (e.g., over- or under-counting) and establish a trusted tracking methodology. • Use data to identify capacity, monitor service levels, and demonstrate measurable improvement to the client. • Establish and maintain a centralized documentation and knowledge-management process for client directives, reducing reliance on individual knowledge. • Partner with HR and recruiting to accelerate hiring, rebuild the candidate pipeline, and stabilize staffing levels.

• Lead end-to-end implementation projects for healthcare payer and claims operations clients • Develop and manage comprehensive project plans, timelines, and deliverables • Ensure requirements are clearly documented and aligned with transactional workflows • Drive milestone achievement and ensure high-quality delivery • Conduct proactive risk management and implement mitigation strategies • Manage implementations involving healthcare claims processing and EDI transactions (837 formats) • Oversee paper-to-EDI transformation workflows • Support integrations, data mapping, and transaction validation processes • Partner with technical and operations teams on transactional-side healthcare implementations (non-clinical focus) • Provide leadership during UAT, system integrations, and go-live readiness • Serve as primary point of contact for customer stakeholders • Lead client and internal status meetings • Create and distribute status reports and executive updates • Apply healthcare payer domain knowledge to address client requirements • Build strong partnerships with customer counterparts and internal teams

• Review and adjudicate medical claims, ensuring accurate coding, data entry, and application of appropriate reimbursement methodologies. • Verify patient eligibility, provider credentialing, and coverage details to facilitate accurate claims processing. • Communicate with internal resources, and internal stakeholders to resolve claim discrepancies, request additional information, or clarify issues. • Participate in ongoing training and professional development activities. • Maintain accurate and detailed records of claims processing activities. • Review claim forms and supporting documents • Determine eligibility, verify data accuracy • Request additional information when needed • Process claims end-to-end • Identify and escalate complex or unusual claims for further review or investigation. • Participate in ongoing training and professional development activities. • Handle more complex claims with multiple services, providers