Member Benefit Specialist

Imagine360 is seeking a Member Services Professional (Navigator) to join the team! In this role you will provide end-to-end support for members by answering inbound inquiries and proactively guiding them through their healthcare journey. You will serve as a single point of contact to explain benefits, help locate and schedule care, support claim and billing questions, and coordinate with internal and external partners to remove barriers to care. By educating members on available resources and advocating on their behalf, you will help members navigate the complexities and costs of healthcare with confidence.

Position Location: 100% remote

Responsibilities include but are not limited to:

Deliver above-and-beyond service across multiple channels (phone, email, portal) while maintaining ownership of each member issue through resolution

Act as a dedicated member navigator and advocate, guiding members to the right resources, next steps, and cost-conscious care options

Explain health benefit coverage, including accumulators, explanation of benefits (EOBs), out-of-pocket maximums, reimbursement levels, and eligibility

Become an expert in benefit administration, FSAs, HSAs, HRAs, and alternative benefit payment designs (including reference-based pricing)

Support members with provider research, appointment scheduling, and medical record retrieval; coordinate next steps to reduce handoffs and delays

Assist with claims and billing questions by researching issues, clarifying what is needed, and coordinating with internal teams and external partners as appropriate

Educate members on pre-service and post-service steps to optimize their healthcare experience, including how to prepare for care and what to expect after services

Anticipate member needs, conduct research on their behalf, and follow up to confirm understanding and completion of next steps

Resolve member complaints and escalate complex issues appropriately while keeping the member informed throughout the process

Collaborate with internal and external partners to ensure best-in-class service delivery and timely resolution

Treat all calls and correspondence using established procedures, including strict adherence to HIPAA guidelines and HIPAA Privacy Rules

Document interactions accurately in appropriate software (e.g., Collybus, Javelina, GBAS) and maintain thorough case notes to support continuity of care

Required Experience/Education:

High school diploma or GED required (associate or bachelor's degree preferred)

1+ year healthcare industry experience in a member-facing, patient advocacy, care navigation, or benefits-focused role

1+ year experience delivering customer/member-focused solutions and education in a call center, virtual/telephonic, or in-person environment

Experience verifying medical benefits and/or supporting benefit inquiries (preferred)

2+ years healthcare experience (carrier, TPA, patient advocate, or other benefits-focused role) preferred

Medical claims exposure (ICD-9/10, CPT, claim forms) preferred

Skills and Abilities:

Proficient in Microsoft Outlook, Word, and Excel

Service-driven, member-first mindset with strong empathy and professionalism

Strong verbal and written communication skills with the ability to explain complex benefit concepts clearly

Ability to assess needs, problem-solve, and coordinate next steps across multiple partners to achieve resolution

Aptitude for learning and retaining detailed plan and process information

Comfortable documenting in multiple systems while maintaining accuracy, confidentiality, and HIPAA compliance

What can Imagine360 offer you?

Multiple Health plan options

Company paid employee premiums for disability and life insurance

Parental Leave Policy

20 days PTO to start / 10 Paid Holidays

Tuition reimbursement

401k Company contribution

Company paid Short & Long term Disability plus Life Insurance

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**