Imagenet LLC

Claims Specialist

• Responsible for leading and managing a team of claims examiners
• Ensure accurate, compliant, and timely processing of medical claims
• Serve as a critical bridge between frontline operations and leadership
• Drive performance against SLAs, quality standards, and productivity targets
• Accountability for team performance, coaching and development, and process improvement
• Ensure adherence to Medicare regulations and CMS guidelines
• Oversee day-to-day medical claims processing
• Monitor and manage service level agreements (SLAs), turnaround times, and production
• Apply deep working knowledge of CMS regulations, Medicare auditing standards, and payer guidelines
• Review claims and audit results to identify trends and training opportunities
• Analyze and manage key performance indicators including quality scores, error rates, productivity, and attendance
• Prepare and present operational and business reviews
• Identify operational risks, performance gaps, and improvement opportunities

Claims Examiner Team Leader

Healthcare Advocate

• Handle healthcare providers regarding claims, payments, appeals, and other account-related inquiries.
• Respond to provider inquiries received via E-Mail, Fax, and web requests in a timely and professional manner.
• Provide accurate claim status updates and explain claim outcomes based on company guidelines.
• Resolve provider concerns by researching claim information and coordinating with internal departments when necessary.
• Deliver exceptional customer service while meeting established quality and productivity standards.
• Review claims requiring additional research, reprocessing, or finalization.
• Process faxed claims and review Explanation of Benefits (EOBs).
• Verify claim information and ensure requests are handled accurately.
• Escalate complex issues following established procedures.
• Provide status updates on provider appeals and request additional information when necessary.
• Process requests for upheld and late submission letters.

Healthcare Service Advocate

Financial Planning and Analysis

• Lead the annual budgeting and planning process.
• Develop monthly forecasts for revenue, expenses, cash flow & profitability.
• Provide actionable financial insights to support strategic decision-making.
• Partner with operational leaders to improve financial performance.
• Develop executive dashboards and key performance indicators (KPIs)
• Recruit, mentor and develop FP&A team members.
• Support the evaluation, financial analysis and execution of M&A.

Director, Financial Planning & Analysis

General

• Accountable for daily claims operations to meet accuracy, productivity and quality goals.
• Conduct regular weekly, monthly, and quality reviews, error trend analysis, and corrective action planning.
• Manage team performance through coaching, performance monitoring, and issue resolution.
• Develop and mentor examiners, identifying future leads and SMEs.
• Partner with training and QA teams to strengthen onboarding, refresher training, accuracy, and consistency.
• Handle client or stakeholder communication, escalations, and operational updates in a timely and professional manner.
• Provide regular business updates on team performance, quality, service levels, and improvement actions.
• Drive continuous improvement initiatives to reduce errors, delays, and rework.
• Ensure adherence to operational processes, controls, and compliance requirements.
• Collaborate with cross-functional teams such as QA, training, workforce management, HR, and client services to support execution.
• Attend and successfully complete all examiner training, certification, and nesting requirements alongside new hire examiners to develop a thorough understanding of client policies, workflows, systems, and claim adjudication processes.
• Maintain hands-on claims adjudication responsibilities including processing claims, auditing claims, and serving as the primary hospital claims subject matter expert.

Hospital Claims Team Leader

Accounting Manager

• Take ownership of end-to-end accounting operations for PH Operations.
• Ensure financial records are accurate, compliant, and decision-ready.
• Play a key role in financial reporting, payroll, statutory compliance, audits, and cash flow forecasting.
• Help leadership understand the numbers behind business decisions.

• Lead end-to-end client implementation, from discovery through go-live and stabilization
• Translate client requirements into operational workflows, SOPs, and staffing models
• Develop and execute detailed implementation plans, including timelines and milestones
• Identify risks early and proactively drive mitigation strategies
• Partner with Training, QA, IT, and Workforce Management teams to ensure readiness across all workstreams
• Coordinate system setup, user acceptance testing (UAT), and access provisioning with IT and client teams
• Ensure all systems, tools, and environments are fully tested and production-ready prior to go-live
• Support development of process documentation, job aids, and knowledge base materials
• Validate workflows for claims processing, including escalation paths and exception handling
• Ensure processes are scalable, efficient, and aligned with client expectations
• Perform standard Team Lead responsibilities including team oversight, performance management, and reporting
• Take ownership of Quality Assurance and Training functions during the implementation phase
• Provide hands-on support in building, testing, and executing processes

Healthcare Claims Team Lead

QA Engineer

• Lead quality assurance and training programs supporting U.S. 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.

Training and QA Manager – US Healthcare Operations

Human Resources

• Support onboarding processes for U.S. and Philippines employees, including E-Verify processing (U.S.), background checks, and scheduling orientation
• Provide recruitment coordination support for U.S. and PH hiring efforts (interview scheduling, candidate communication, etc.)
• Ensure complete submission of new hires of the Pre Employment Requirements have been completed based on timeline
• Perform HR administrative tasks for the Philippine team
• Distribute new hire and exit interview surveys and track responses
• Upload and manage employee documents in BambooHR, ensuring profiles are complete and up to date
• Assist with travel planning and booking for employees as needed
• Coordinate 401(k) notifications and communications (U.S.)
• Support Open Enrollment activities for both U.S. and Philippines employees
• Ensure that all offboarding documents and process have been complied with
• Assist with additional HR projects and administrative tasks as needed