Group Set up Specialist

If you’re looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we’re looking for you. At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees. As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn’t a work life and a home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee’s life. One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options. With competitive compensation packages, premier investment support, enriching personal development and more, we strive for our employees’ job satisfaction and success. Compensation: $53, 667.86 - $69, 768.32 with a rich benefits package that includes profit-sharing. JOB DESCRIPTION SUMMARY Responsible for set-up and rate structure of new groups, maintaining and updating existing groups/clients for Western Growers Assurance Trust (WGAT), and Pinnacle Claims Management Inc. (PCMI) using the Health Care Processing System (HCPS). Incumbent will provide management and maintenance for all new business changes, including the set-up and structure of Flexible Spending Account (FSA) groups. This position will research and analyze group documents to ensure accurate set-up and invoicing. QUALIFICATIONS • High school diploma or equivalent, and two (2) to four (4) years working with healthcare enrollment and billing, preferred. • Knowledge of Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), Cal-COBRA, Employee Retirement Income Security Act (ERISA), and Section 125/105 legislation, highly desired. • Thorough knowledge of generally accepted Health Care Eligibility guidelines, Billing procedures and Plan structure. • Advanced computer skills in Microsoft Office Suite and the ability to develop a strong proficiency working with a proprietary Health Care system. • Self-motivated, organized and effective in a fast-paced, deadline-oriented environment. • Experience providing Customer Service to a variety of client contacts via email, online and telephone. • Demonstrated ability to identify, research and resolve complex technical problems with minimal direction. • Proven project management abilities –including time and task management, delegating assignments, and working collaboratively to meet deadlines Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds. • Home router with wired Ethernet (wireless connections and hotspots are not permitted). • A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.) • A functioning smoke detector, fire extinguisher, and first aid kit on site. DUTIES AND RESPONSIBILITIES System Management and Maintenance • Use a bulleted list to list all of the duties and responsibilities under this role. • Setup and entry of all new business and group changes for the HCPS for WGAT and PCMI for all plan types. • Accurate entry of all renewal plan and rate changes for all accounts. • Maintain accuracy of membership designation and fees on HCPS. • Set-up, enrollment and auditing of new Section 125/105 (FSA/HSA) accounts on the HCPS. • Research and analyze documentation pertaining to new or existing accounts. • Create recommendations for account structures relating to billing and invoicing using the HCPS system. • Complete all financial adjustment paperwork to accounts that have modifications that create a financial impact. • Manage the invoice process. • Setup the client online system and the vendor remit system. • Audit all information entered into the HCPS, Client Online, and Vendor Remit system for accuracy. • Resolve Group Setup and/or billing as they arise. • Consistently meet processing cycle time standards and production due dates as set forth by management. Reporting • Develop and maintain Group Setup status and production reports for Management. • Generate sample invoice reports, plan audit reports and census reports as needed. • Generate specialized reports. • Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses. • Create and document Standard Operating Procedures (SOP’s). • Identify, initiate and implement process improvements and/or innovation. Customer Service • Resolve Group Setup and/or billing issues as they arise. • Serve as representative of Western Growers/PCMI displaying professionalism, knowledge, customer service and discretion in all interactions with other members of the Western Growers/PCMI community and their customers. • Consistently meet processing cycle time standards and production due dates as set forth by management. Other • Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results. • Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet. • Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA [1] required protection of all confidential/protected client data. • Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit). • All other duties as assigned. PHYSICAL DEMANDS/WORK ENVIRONMENT The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate