Invoice Fee Specialist

Imagine360 is seeking an Invoice Fee Specialist to join the team!  The Invoice Fee Specialist is responsible for reviewing, validating, and processing Pharmacy Benefit Manager (PBM) vendor invoices to ensure accuracy, completeness, and compliance with contractual agreements. This role plays a critical part in financial oversight by verifying billed fees, identifying discrepancies, and ensuring proper allocation of costs related to pharmacy benefit administration. The analyst works closely with PBM vendors and internal departments to resolve billing issues, support month-end closing, and maintain strong internal controls.

Position Location: 100% remote

Responsibilities include but are not limited to:

• Review and process PBM vendor invoices for accuracy, completeness, and contract compliance
• Verify billed fees against fee schedules, service agreements, utilization reports, and supporting documentation
• Identify and resolve discrepancies, including overcharges, duplicate fees, and missing or incorrect documentation
• Reconcile invoice amounts with claims data, enrollment counts, service periods, and contract terms
• Ensure proper allocation of administrative fees, per-employee-per-month (PEPM) charges, and claim-related costs
• Coordinate with PBM vendors to resolve billing issues, corrections, and adjustments in a timely manner as well as internal communication with the group assigned Relationship Manager
• Prepare approved invoices for payment processing and internal authorization
• Maintain detailed records, documentation, and audit trails for invoice reviews and approvals
• Support month-end close and financial reporting related to TPA and PBM expenses
• Ensure compliance with internal controls, accounting policies, and contractual obligations
• Serves as back up within Support Services team

Required Experience/Education:

• Prior TPA experience preferred

• Three or more years of medical experience requiring knowledge of medical terminology and procedures required or equivalent combination of education and experience

Skills and Abilities:

• Develop new or improved current internal processes to improve quality
• Flexible, detailed, and able to successfully adapt to change
• Working knowledge of computers and software, including but not limited to Microsoft Office products
• Strong written, oral and telephonic communication skills
• Demonstrated ability to work independently, prioritize workloads, multitask
• Demonstrated ability to work in a fast-paced environment while maintaining accuracy and production requirements

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**