What are the responsibilities and job description for the Implementation Auditor position at Western Growers Family of Companies?
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.
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.
JOB DESCRIPTION SUMMARY
Position reports to the Supervisor, Benefit Installation & Distribution and performs in-depth plan coding and testing of new and existing business accounts. This position will ensure that all new and existing health (medical/dental) insurance plans underwritten by the Western Growers Assurance Trust (WGAT) and those of Pinnacle, Inc. (PCMI) are in compliance with the respective employers’ summary plan descriptions.
Qualifications
- BS/BA degree in Business or related field and a minimum of three to five years of recent experience as a medical/dental claims auditor or plan testing experience, preferred.
- Exceptional understanding and ability to interpret summary plan descriptions of employee medical/dental benefits.
- Strong ability to work efficiently and effectively in a multiple task, multi-project, and multi-demanding
- environment to meet expected goals, dates, and milestones.
- Ability to anticipate problems, recommend solutions, and exercise best judgement.
- Excellent writing, editing, and proofreading skills to compose and edit correspondence, reports, emails, and other written materials.
- 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.
Duties And Responsibilities
Testing
- Using close and comprehensive analyses, verify new and existing plans loaded on the Company’s claim management system against the appropriate Summary Plan Description to determine the accuracy of present and future claims payments.
- Test all new plans prior to loading them into production.
- Work with programmers to test claims and related system programs to verify impact within the HCPS.
- System analysis and testing of mass system updates.
- Plan coding of new business and plan changes.
- Communicate with other operational departments, as necessary, to insure smooth integration of new plans for both WGAT and PCMI moving into production.
Reporting
- Update monthly data reporting for client communication of Summary Benefits of Coverage.
- Provide monthly reporting of all requested plan issues submitted from the Claims department.
- 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.
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.
