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: $41,751- $59,275 with a rich benefits package that includes profit-sharing.

Job Description Summary

This position reports to the Supervisor, Administration This position is responsible for processing financial transactions in the company’s financial processing systems as it relates to group and individual billing, automated clearing house (ACH), and cash receipt processing. They also maintain and balance group and individual accounts receivables including delinquency processing and terminations. Additionally, they manage receipt of group administration fees, process vendor payments, invoice for third party administrator (TPA) claims processing, and manage receipt and application of claims funding.

Qualifications

• 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.
• Demonstrated ability to multi-task, work in a fast paced environment, meet established deadlines, and work independently with minimal supervision or in team environment.
• Proficient 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.
• Advanced customer service skills.
• Moderate ability to analyze and resolve technical problems and/or client inquiries as they arise.
• Intermediate 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.

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.
• Verify and authorize the release of PCMI vendor payment within four business days of account funding.
• Process funding and releasing self-funded claims payments.
• Perform the preparation and completion of schedule “A” and Tax form 5500.
• Month End Financials completed and delivered to Accounting by the fifth (5th) business day of the month.
• Support the administration of Bank of America lockbox, credit card and ACH/Wire programs.
• Support the administration of retiree invoicing & receivable management program(s).
• Support the administration of Flexible Spending Account (FSA) 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

Transaction Processing

• 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/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.

Customer Service

• Work with Eligibility Specialists to research/resolve unpaid and/or outstanding balances for PCMI employer groups, and COBRA accounts.
• Display professionalism, knowledge, customer service and discretion in all interactions with other members of PCMI community and their customers.

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 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.