Join our team of dedicated professionals who are committed to ensuring our clients can provide affordable health benefit solutions for their employees.
Part of the Western Growers Family of Companies, Pinnacle Claims Management is a 3rd party administrator that provides health benefits administration and related services to companies that self-fund their insurance. We are also a contracted partner with CCSB.
Pinnacle is independently owned and has been serving clients for 20+ years. We are also part of the Western Growers Family of Companies.
For more details on open positions, visit our careers page!
Compensation:$48,012- $67,416 with a rich benefits package that includes profit-sharing.
Job Description Summary
This position reports to the Supervisor of Administration and is responsible for processing financial transactions in the Health Care Processing System (HCPS) and related systems for group and individual billing, Automated Clearing House (ACH) processing and Cash receipt processing. They also maintain and balance group and individual Accounts Receivables including delinquency processing and terminations, manage receipt of group administration fees and process vendor payments. Additionally, they are responsible for invoicing for Third Party Administrator (TPA) claims processing and manage receipt and application of claims funding. Lastly, they mentor and support the development of the Financial Specialist level I and II in conjunction with the Team Lead.
BA/BS degree in accounting, finance or business related field preferred plus four years' experience working in a related field or equivalent combination of education and experience preferred.
Highly skilled at establishing priorities, multi-tasking, working in high paced environment and meeting deadlines.
Ability to work independently with minimal supervision and in a team environment.
Advanced knowledge of end-user office software i.e. calendaring, word-processing, spreadsheet and email and the ability to develop a strong proficiency working with a proprietary Health Care system.
Excellent written and oral communication skills, to include modern business communications, formatting of professional letters, reports and phone etiquette.
Customer service oriented.
Ability to analyze and resolve technical problems and/or client inquiries as they arise.
Advanced knowledge of generally accepted Health Care Eligibility and Billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), Cal-COBRA, Multiple Employer Welfare Arrangement (MEWA) and Employee Retirement Income Security Act (ERISA) regulations.
Knowledge of health insurance industry and standard health care eligibility provisions.
Ability to work overtime as needed.
Duties And Responsibilities
Account Management & Maintenance
Maintain/manage all Pinnacle Claims Management, Inc. (PCMI) contribution/premium reimbursements, COBRA/Retiree reimbursements, and vendor pass thru payments for PCMI.
Manage complex account reconciliations, special assignments, and build ad hoc reports.
Verify and authorize the release of PCMI vendor payment within 4 business days of account funding.
Manage the process of funding and releasing self-funded claims payments.
Prepare and complete Schedule "A" and Tax Form 5500.
Analyze and resolve technical problems and/or client inquiries as they arise
Month End Financials Complete and deliver month-end financials to Accounting by the established deadline.
Manage and maintain Bank of America lockbox, credit card and ACH/Wire programs.
Manage and maintain retiree invoicing and receivable management program(s).
Maintain FSA (Flexible Spending Account) program.
Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses
Create and document a minimum of one new Standard Operating Procedure (SOP) annually.
Identify, initiate and implement at least one process improvement and/or innovation annually
Process and verify the necessary corrections on manual adjustments posted to group ledger on HealthCare Processing System for PCMI, Western Growers Assurance Trust (WGAT) and individual accounts (COBRA).
Verify and authorize refund for terminations and overpayments on all accounts.
Apply cash to appropriate ledgers and research /correct application issues.
Provide back-up resource for invoice generation, daily cash application and other staff financial duties.
Process related written and verbal account inquiries to its conclusion in a timely manner to include research on as needed basis.
Cross train on Eligibility processing and handling as necessary.
Act as liaison to other departments for resolution of issues that may arise.
Interface effectively with internal departments and external vendors, brokers or other business contacts to coordinate interrelated activities and to resolve eligibility and/or billing issues as they arise.
Provide timely and effective customer service to clients for requests, inquiries or issues concerning enrollment and/or billing items on their account.
Consistently meet processing cycle time standards and production due dates.
Mentor Financial Specialists I and II.
Serves as representative of PCMI displaying professionalism, knowledge, customer service and discretion in all interactions with other members of PCMI community and their customers.
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.
All other duties as assigned.
Physical Demands/Work Environment
The physical demands and work environment described here represent those that an employee must meet to perform this job's essential functions successfully. Reasonable accommodations 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.