Group Set Up Specialist

Description

Part of the Western Growers Family of Companies, Western Growers Assurance Trust (WGAT) was founded in 1957 to provide a solution to a need in the agricultural community — a need for employer-sponsored health benefit plans not previously available from commercial health insurance carriers. WGAT is now the largest provider of health benefits for the agriculture industry. The sponsoring organization of WGAT is Western Growers Association, created in 1926 to support the business interests of employers in the agriculture industry. WGAT’s headquarters is located in Irvine, California.

WGAT’s mission is to deliver value to agriculture-based employer groups by offering robust health plans that meet the needs of a diverse workforce. By working at WGAT, you will join a dedicated team of employees who truly care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to WGAT today!

Compensation: $45,091 - $63,617 with a rich benefits package that includes profit-sharing.This is a remote position and can reside anywhere in the U.S.

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.
• Kno w l e d g e o f H e al t h In s u ra n c e P ort ab ility an dAcco un t ab ili t yAct( H IPAA ) ,Co n s olid a ted O m n i bu sB ud g e t R e co n cilia t ionAct ( CO B RA ) , C a l - C O BR A , E m p lo y e e R e ti r e m e n tI n come S e c u rityA c t(ERI S A ) , an dSe c ti o n125/1 0 5 l e g i s la t ion,highly desired.
• T h or ou gh k n o w l e d ge o f g e n e r ally a cc e p ted H e al t h C are E lig i b ilityg u i d e line s ,Bi l l i n g p r o c edu r e sa n d P lan s tr u ct u r e .
• A d v a n c e dc o m pu ter s kil l sinMicro s o f tO f f iceS u i t ea n d th e ab ility t o d eve lopa stro n g p r o f ici e n cy w or k i n gwitha p r op ri e t a ry H e al t hCaresy s t e m .
• S e l f -m ot i v a t e d , o rga n izeda n de f f e ct i v eina fa s t - p ace d , d e a d line -oriented e nv iro n me n t.
• E x p e ri e n ce p r ov i d i n gCu s t o m e rS e r v i c e t oa v ari e ty o fcl i e n tco n t a cts v ia e m ail, on line an d t e l e ph o n e .
• D em o n s tr a ted ab ilitytoi d e n tify,r ese a r ch an dr es ol v ecom p l e xtech n ical p r ob l e m s w ith m i n i m al d ir e ctio n .
• Pr o ve n p r o je c t m a n age m e n ta b ilities – i n clu d i n g t i m e an d t ask m a n ag e me n t, d e l e ga t i n g a ss ig n me n t s , an dwor k i n g colla b orati ve ly t o m ee t d e a d l i n e s
  
  

Duties And Responsibilities

System Management and Maintenance

• 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.
• Co n s i s t e n tlym e e t p r o c e ss i n gc y cle t i m esta nd ar d s an d p r odu ction du e d a t e s a ss e t f orth b yma n age me n t .
  
  

Reporting

• D e v e lop an dmai n t a inGro u pSet u psta tu s an d p r odu ction r e p orts f orMa n ag e m e n t.
• 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 a minimum of one new Standard Operating Procedure (SOP) annually.
• Identify, initiate and implement at least one process improvement and/or innovation annually.
  
  

Customer Service

• Resolve Group Setup and/or billing issues as they arise.
• S e r v e a s r e p r e s e n t a ti v e o f We s tern G r o we r s /P C MI d i s p la y i n g p r o f es s io n ali s m , kn o w l e d g e ,c u s t om e r se r v i c e an d d i s cr e t ion in a lli n teracti on swith o t h e r m e m b e r s o f th e We s ternGr o we r s /P C MIco m m un ity an d t he irc u s t o me r s .
• Co n s i s t e n tlym e e t p r o c e ss i n gc y cle t i m esta nd ar d s an d p r odu ction du e d a t e s a ss e t f orth b yma n age me n t .
  
  

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.
• 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 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.