Claims Auditor

Pinnacle Claims Management is seeking a Claims Auditor to perform in-depth audits to ensure existing health benefit plans of Western Growers Assurance Trust and Pinnacle Claims Management clients are in compliance with the respective employers' summary plan descriptions.

Requirements

• BS/BA degree preferred and a minimum of one (1) to three (3) years of recent experience as a medical/dental claims auditor, preferred.
• At least three (3) years' experience processing group health claims, highly desired.
• Knowledge of the Patient Protection and Affordable Care Act (PPACA), Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), California-COBRA, and Employee Retirement Income Security Act (ERISA) regulations.
• Knowledge of Current Procedural Terminology (CPT) and International Statistical classification of Diseases and Related Health Problems (ICD-10 & ICD-9) and medical terminology.
• Exceptional understanding and interpretation of summary plan descriptions of employee medical/dental benefits.
• Good ability to interpret provider contracts.
• Proven ability as a self-starter to manage timelines and commitments.
• Proficient in end-user software, e.g., word-processing and spreadsheets.
• Exceptional written and verbal communication skills.
• Strong knowledge of business math.

Benefits

• Profit-sharing
• Flexible work arrangements
• Competitive compensation package