Imagenet LLC

Claims Specialist

• 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.
• Review, evaluate and process all types of claims such as Encounter data, Professional and Institutional Claims for all lines of business e.g., Commercial, Point of Service (POS) Senior/Medicare, Preferred Provider Organization (PPO), Medi-Cal, etc.
• Ensure claims payment & denial accuracy and compliance to turnaround time
• Participate in ongoing training and professional development activities.
• Maintain accurate and detailed records of claims processing activities.
• Identify and escalate complex or unusual claims for further review or investigation.
• Handle more complex claims with multiple services, providers

Medical Claims Examiner

Project Manager

• 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

Implementation Project Manager

Recruitment

• End to end recruitment for Ph and US roles across various levels (entry-level to executive) preferably in a BPO or high-volume setting.
• Manage and execute ramp hiring projects, ensuring aggressive hiring targets and timelines are met.
• Partner closely with hiring managers and business leaders to understand workforce demands and provide strategic hiring solutions.
• Supervise, mentor and support junior talent acquisition.
• Develop and implement effective sourcing strategies using job boards, social media, referrals, and talent pipelines.
• Conduct candidate screening, interviews, assessments, endorsements, and offer management.
• Ensure a positive candidate experience from initial contact through onboarding.
• Track, maintain and analyze recruitment KPIs.
• Ensure compliance with company recruitment policies.
• Ensure real time tracking of all Talent Acquisition Dashboards.
• Continuously improve recruitment processes and contribute to employer branding initiatives.

Medical Claims Examiner

Implementation Project Manager

Senior Talent Acquisition Specialist