Implementation Auditor

We are looking for an Implementation Auditor to join our team at Pinnacle Claims Management. As an Implementation Auditor, you will perform in-depth plan coding and testing of new and existing business accounts, ensuring compliance with summary plan descriptions. You will work closely with our team to analyze and interpret group health benefits provisions, administrative policies, and provider contracts.

Requirements

• BS/BA degree in Business or related field
• Minimum of 3-5 years of recent experience as a medical/dental claims auditor or plan testing experience
• Exceptional understanding and ability to interpret summary plan descriptions
• Strong ability to work efficiently and effectively in a multiple task, multi-project, and multi-demanding environment
• Excellent writing, editing, and proofreading skills
• Proficient ability to analyze and interpret group health benefits provisions, administrative policies, and provider contracts
• Previous experience with conducting research and presenting complex information
• Excellent communication and interpersonal skills
• Superior organization skills and high attention to detail
• Ability to learn complex business processes and appropriately apply knowledge to make informed decisions
• Advanced skills in Microsoft Office applications
• Knowledge of medical terminology and familiarity with ICD10, CPT, HCPC, and CDT codes

Benefits

• Competitive compensation package
• Profit-sharing
• Flexible work arrangements (work-from-home, in-office, or hybrid options)
• Rich benefits package
• Premier investment support
• Enriching personal development opportunities