Billing Specialist

Imagine360 is seeking a Billing Specialist to join the team! The Billing Specialist is responsible for the accurate, timely, and compliant generation of client premium billing. This role serves as a critical link between operational teams and clients, ensuring that all billing activity reflects current eligibility, plan configurations, rates, and client expectations. The Billing Specialist manages an assigned portfolio of client groups, performs detailed billing audits, resolves discrepancies, responds to billing inquiries, and collaborates with internal departments to ensure invoices are delivered accurately and on schedule.

Position Location: 100% remote

Responsibilities include but are not limited to:

Client Billing Administration

• The Billing Specialist owns the monthly premium billing for assigned client groups and is accountable for producing accurate invoices that meet established deadlines and client expectations. This includes:
• Creating, reviewing, and releasing monthly premium bills.
• Managing a portfolio of assigned groups and ensuring all required billing activity is completed on schedule.
• Applying established billing methodologies, fee structures, and client-specific requirements.

Billing Review and Quality Control

• Reviewing billing details for inconsistencies, discrepancies, or missing information.
• Investigating billing errors and performing required corrections prior to invoice distribution.
• Verifying fees, rates, and administrative charges against approved documentation and contractual requirements.
• Ensuring annual renewals, mid-year rate changes, and new group implementations are accurately reflected on invoices.
• Reviewing and validating group rates through established billing processes.
• Updating billing calculations for rate changes, renewals, and client modifications.
• Coordinating with Configuration, Eligibility, Finance, and Client Banking teams when rate discrepancies are identified.
• Confirming that billing data aligns with approved client setups and system configurations.

Documentation and Record Retention

• Following company naming conventions and documentation standards.
• Organizing and storing billing files and supporting documentation within approved company systems.
• Maintaining audit-ready records for billing transactions, rate changes, and client communications.
• Ensuring billing documentation can be easily retrieved for future reference or audit purposes.

Client and Internal Support

• Respond to client billing inquiries in a professional and timely manner.
• Partnering with Client Experience, Member Experience, Eligibility, Finance, Configuration, and Banking teams to resolve billing issues.
• Research invoicing concerns and providing clear explanations regarding charges, adjustments, and billing calculations.
• Communicating effectively with clients, brokers, and internal stakeholders at various organizational levels.

Performance and Quality Management

• Reviewing production reports and performance metrics throughout the month.
• Meeting assigned billing volume and turnaround expectations.
• Maintaining established quality audit scores.
• Reviewing and responding to quality audit findings within required timeframes.
• Implementing corrective actions when opportunities for improvement are identified.

Required Experience/Education:

• High School Diploma or GED

Skills and Abilities:

• Experience interpreting large data sets and identifying discrepancies.
• Strong mathematical and reconciliation skills.
• Advanced Microsoft Excel skills, including data manipulation, validation, and reporting.
  • Proficiency with Microsoft Lists. Excel and related Microsoft Office applications.
  • Working knowledge of Word, PowerPoint, Visio, and Copilot.
• Ability to navigate billing and operational systems efficiently.
• Strong verbal and written communication skills.
• Ability to explain complex billing concepts to clients and internal teams.
  • Professional customer service approach when handling escalated billing concerns.
  • Comfortable interacting with clients, brokers, and operational departments.
• Effective time-management and prioritization skills.
• High level of accuracy and attention to detail.
• Strong organizational and documentation skills.
• Follow HIPAA guidelines and protect confidential member information.
• Adhere to established billing processes and operational procedures.
• Maintain compliance with company standards for quality, documentation, and client service.
• Participate in team meetings, training sessions, quality reviews, and continuous improvement initiatives.

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**