Join our team of dedicated professionals who are committed to ensuring our clients can provide affordable health plan benefit solutions for their employees.

Pinnacle Claims Management provides health benefits administration and related services to companies with 100 lives that self-fund their insurance. Pinnacle also provides a full suite of complementary solutions, including health management and wellness services, pharmacy benefit management, general underwriting and stop-loss insurance, and print and transaction solutions.

Pinnacle is independently owned and has been serving clients for nearly 25 years. We are also part of the Western Growers Family of Companies.

Job Description Summary

This position reports to the Senior Director, Client Services and México Operations for Pinnacle Claims Management (PCMI) and is responsible for managing customer accounts during and following the sale of employer benefit programs and services including Pinnacle third party administration (TPA), Pinnacle Rx Solutions (PRxS), Pinnacle Health Management (PHM), and complete ancillary benefits offered by PCMI vendor partners including the Western Growers Insurance Services (WGIS) employer benefit programs. The Account Manager working in collaboration with internal operation and administration departments will help coordinate and assist in pre and post-sale implementation and plan support of the customer’s account. Position also supports new sales expansion activities through cross sale initiatives.

Qualifications

• BA/BS and three to five years of direct Account Management and service experience in a TPA organization, employer health benefits, and employee health care benefits preferred.
• Exceptional expertise working in a TPA and employer health benefits market and its relative services, policies, common practices, and procedures.
• Considerable knowledge of Pharmacy Benefit Manager (PBM) operations and customer care, preferred.
• Significant knowledge of Wellness and Disease Management programs, preferred.
• Advanced personal computer operation skills in various software applications including word processing, spreadsheet, electronic mail and presentation.
• Considerable composition and writing skills including grammar, spelling and proper use of punctuation.
• Excellent verbal communication skills with the ability to maintain strict confidentiality on matters relating to protected health care information.
• Excellent organization skills, attention to detail with high degree of accuracy, and the ability to work independently and exercising judgement.
• Ability to meet deadlines under pressure.
• Ability to analyze information and evaluate results to choose the best solution.
• Active Life & Health insurance license in California.
• Verifiable, clean DMV record and the ability to travel up to 30% of the time to locations throughout the US (mainly California and Arizona).

Duties And Responsibilities

Account Management

• Responsible for the overall servicing of their overall book of business under the PCMI platform.
• Provides day-day administration and delivering on the needs of the clients and brokers as it relates to Pinnacle TPA, PRxS, PHM and ancillary products.
• Supports and advises clients and brokers on self-funding, pharmacy benefits management, care management and utilization review, wellness, stop loss and print and distribution.
• Maintains client reference files on server for all assigned accounts, detailing past work and work-in-progress, and all pertinent information as it relates to meeting the customer’s/broker’s needs.
• Monitors projects to ensure they proceed according to plan and deadlines and identifying potential problems before they occur.
• Executes all product renewals in a timely manner to ensure a high PCMI retention rate.
• Develops a keen understanding of PCMI system tools including PERC/WERC/Healthview and HCPS operating systems to manage customer expectations and deliverables.
• Focuses on opportunities to drive results such as process improvement, expectations management and resolutions.
• Keeps current on laws and regulations that impact the medical insurance industry.

Upselling and Cross-sell

• Conducts analysis of reporting relative to claims history, pharmacy spend, chronic disease, etc. and determines if the clients’ health plans may be more successful in conjunction with PCMI ancillary products.
• Strategizes and collaborate with Sales in an effort to sell additional Pinnacle Products to create additional revenue for PCMI.
• Prior to renewal, works with brokers to identify opportunities to focus such efforts on.
• Coordinates with other internal departments to generate customer specific proposals on our PCMI offerings.
• Has a clear understanding of the competitive landscape to effectively position PCMI products.

Other

• Utilizes 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 in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.
• Maintain a clean DMV record and the ability to travel to locations throughout the US (mainly California and Arizona) up to 30% of the time.
• Maintain an active Life & Health insurance license in California.
• 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 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 travel to both indoor and outdoor areas that can vary in exposure and temperature. The employee is frequently required to operate a motor vehicle, use objects, tools, or controls, and/or required to lift up to 50lbs. The noise level in the work environment is usually moderate.