This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description This role involves processing and adjudicating insurance claims according to company policies and regulations. - Process and adjudicate insurance claims, ensuring accuracy and compliance - Review and analyze claims to identify discrepancies or issues requiring resolution - Communicate with insurance companies, healthcare providers, and patients regarding claims-related inquiries and disputes - Collaborate with internal teams to gather necessary documentation and information to support claim decisions - Maintain detailed records of claims activity and ensure timely follow-up on outstanding claims - Stay updated on industry changes and payer policies to optimize claims processing and reimbursement rates Qualifications - Associate's degree in healthcare administration, business, or a related field; Bachelor's degree preferred - Minimum of 2 years of experience in claims processing or a related role in the healthcare industry - Strong understanding of medical terminology, coding (CPT, ICD-10, HCPCS), and insurance policies - Excellent analytical skills with keen attention to detail - Proficient in claims management software and electronic health record (EHR) systems - Strong communication skills, both verbal and written, for effective interaction with stakeholders - Able to work independently in a remote setting and manage time effectively to meet deadlines - Comfortable working U.S. hours Company Description Fraud Disclaimer: ReWorks Solutions will never request payment during recruitment or require in-person office visits. All official communication will come from a ReWorks Solutions email address. Please verify any suspicious messages with our team directly.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Our client is seeking to add a Senior Workers' Compensation Claims Adjuster that would have the ability to work remotely. Responsibilities include moderate to complex Workers Compensation Claims throughout the Southeast US. - Investigate claims via telephone, written correspondence, and/or personal contact with claimants, attorneys, insureds, witnesses, and others having pertinent information. - Process assigned claims and determine benefits due pursuant to the client contract. - Work proactively towards claims resolution with defense counsel and clients, while adhering to audit requirements and resolving claims in a timely manner. - Make timely claims payments and adjustments; communicate claim action/processing with claimant and client. - Ensure claim files are properly documented and claims coding is correct. - Provide comprehensive, complete thorough analysis of coverage determination. - Prepare detailed reports, review and prepare responsive correspondence to achieve settlement. Qualifications - 5-10 years of Workers' Compensation claims handling experience. - Active licenses in one or more of the following: NC, SC, and/or GA. - Litigation Experience Required. - Strong verbal and written communication skills. Benefits - Salary: $75K - $90K Annually (based on experience) - Annual bonus potential - Flex schedule and ability to work remotely - 401k Plan - Health and Dental Plan - Generous PTO Company Description

Imagine360 is currently seeking a Manager, Medical Claims to join the team! The Manager, Medical Claims, is responsible for leading the end‑to‑end process of preparing, validating, and submitting stop‑loss claims to ensure timely and accurate reimbursement for high‑cost medical claims. This role oversees daily team operations, establishes workflow and quality standards, and collaborates with internal and external parties to resolve issues and optimize outcomes. The manager drives continuous improvement, ensures compliance with contractual and regulatory requirements, and provides strategic oversight to support financial recovery and operational excellence. Position Location: 100% Remote Supervisory Responsibilities: - Stop Loss Filing Team - Stop Loss Filing Team Supervisors Leadership - Lead, coach, and develop a team of Stop Loss Filing Specialists and Analysts. - Oversee day‑to‑day workflow management, ensuring timely assignment, processing, and submission of all stop loss claims. - Establish performance standards, quality controls, and productivity expectations. - Provide ongoing training to ensure staff expertise in stop‑loss processes, coordination of benefits (COB), and claim documentation requirements. Stop Loss Claims Management: - Manage the complete lifecycle of specific and aggregate stop‑loss filings, including claim preparation, eligibility verification, documentation assembly, and carrier submission. - Audit claims against plan document, stop loss contract, and carrier standards - Facilitate financing of approved claims with finance - Pend claims and issue denials to third party administrator where appropriate - Elevate complex claim issues for clinician or management review Claims Support: - Compile periodic reporting for internal and external parties - Advise on claim projections and development Quality Assurance: - Develop and maintain standardized filing procedures, policies, and best practices. - Performs self-quality monitoring to develop and execute plans to meet established goals - Identify process gaps and lead continuous improvement initiatives to increase accuracy, speed, and reimbursement rates. - Collaborate with peers and cross-departmentally to improve or streamline procedures Education: - High School Diploma or GED. - Associate degree in Business Administration, Healthcare Administration, Finance, or a related field. - An equivalent combination of education and relevant stop‑loss or claims experience may be considered in place of a degree, depending on organizational policy. Experience: - 2-3 years of team leadership or supervisory experience. - Excellent analytical skills, attention to detail, and problem‑solving ability. - Strong communication skills with experience managing external partner relationships. - 8+ years of experience in stop loss insurance, medical claims, health plan operations, or related field. 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 Want to see our latest job opportunities? Follow us on LinkedIn 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**

• Analyzes and processes complex or technically difficult general liability claims by investigating and gathering information to determine the exposure on the claim. • Manages claims through well-developed action plans to an appropriate and timely resolution. • Assesses liability and resolves claims within evaluation. • Negotiates settlement of claims within designated authority. • Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim. • Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level. • Prepares necessary state fillings within statutory limits. • Manages the litigation process; ensures timely and cost effective claims resolution.