Claims Auditor

JOB DESCRIPTION

SUMMARYThis position reports to the Supervisor of Claims and performs in-depth audits to ensure existing health (medical / dental) benefit plans of Western Growers Assurance Trust and Pinnacle Claims Management, Inc. clients are in compliance with the respective employers’ summary plan descriptions.

Qualifications

• BS / BA degree preferred and a minimum of one (1) to three (3) years of recent experience as a medical / dental claims auditor.
• Three (3) years’ experience processing group health claims preferred.
• Knowledge of Current Procedural Terminology (CPT) and International Statistical classification of Diseases and Related Health Problems (ICD-10 & ICD-9) and medical terminology.
• Exceptional understanding and interpretation of summary plan descriptions of employee medical / dental benefits.
• Good ability to interpret provider contracts.
• Proven ability as a self-starter to manage timelines and commitments.
• Proficient in end-user software, ., word-processing and spreadsheets.
• Exceptional written and verbal communication skills.
• Good knowledge of basic business math.

Duties And Responsibilities

Claims Auditing

Claims Department Support

Pinnacle Risk Management Services – Claims – PM6000

Other

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.#LI-Remote