|Claims Examiner l||
Position reports to Claims Supervisor in a production environment. Examiner will review and process medical, dental, vision and electronic claims within the established turn-around time and quality standards of the department. Position may also process flexible spending account (FSA) and health insurance payment demand (HIPD) claims.
|Pharmacy Benefit Analyst||
Reports to the Manager of Cost Containment/Care Management, which is
responsible for Managing Western Growers Assurance Trust’s (WGAT) and Pinnacle Claims Management Inc (PCMI) staff, policies and procedures in the area of Pharmacy Benefits, both third party networks and direct contracts, as necessary to promote and analyze pharmacy plan administrative processes and facilitate clinical drug programs.
|Provider Database Coordinator||
Research and maintain provider files on company’s Health Claims Processing System (HCPSystem) for generation of remittance advice, explanation of benefits (EOB) and Internal Revenue 1099’s. Assist in the maintenance of medical and dental contract fee schedules and usual and customary (U&C) tables on the HCPSystem.
|Director of Claims Operations||
Plans and directs all aspects of Western Growers Assurance Trust’s (WGAT) and Pinnacle Claims Management (PCMI) claim operations functions. Responsible for the development of procedures and policies to enhance and improve the processing of claims and the management of customer service and reinsurance. Leads and directs the work of one managers and claims trainer. Approves personnel activity concerning hiring, training/development, and evaluation of staff performance.
The Project Analyst is responsible for a full range of activities, which ensure the operational effectiveness, and excellence of health plan operations and business set-up. This is a key position within the Operations and Implementation department and is vital to its ongoing success.
The Project Analyst will design, document and manage workflows and provide appropriate recommendations that will positively impact operational effectiveness in the area of health plan operations. The Project Analyst will track, analyze, and report business trends. This position will lead a number of key projects for the department and be the communication liaison between internal operations departments and our external key clients, including Western Growers Insurance Services.
|Manager of Application Programming||
Oversees applications programming activities within the department. Manages work of employees engaged in developing, maintaining, and modifying programs and confirms quality standards of programming are being met. Verifies the accuracy of instructions given to computer programming staff from the user community. Annually reviews computer programming staff. Annually participates in developing the financial budget for the department. Additionally reviews, analyzes, and modifies programming systems including encoding, testing, debugging and documenting programs. Requires Bachelors degree (BA/BS) in Information Systems, Computer Science, Business Administration, or seven to nine years of an equivalent combination of education and experience which has provided both theoretical and practical knowledge in the field. Must be familiar with standard concepts, practices, and procedures within a particular field. Relies on experience and judgment to plan and accomplish goals. Performs a variety of tasks. Works under limited supervision; typically reports to a director or the CIO. An extensive degree of creativity and latitude is required.
|Information Technology||Irvine Headquarters|
|Science & Technology Administrative Assistant||
Position reports directly to the Senior Vice President of Science Technology and Strategic Planning and is responsible for supporting the varied business activities surrounding the functions of the Science Technology and Strategic Planning Unit. Position is also responsible for the overall direction, coordination, implementation, execution and completion of specific projects directed by the Senior Vice President ensuring consistency with the organization’s mission and strategic plan.
|Information Technology||Irvine Headquarters|
|Operations Training Manager||
Position reports directly to the Director of Claims Operations and is responsible for planning, organizing, leading and supervising training activities and deliverables for employee health benefit claims and customer service staff in Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management, Inc (PCMI).
Position reports directly to the Vice President of Marketing and supports the mission of Western Growers to enhance the competitiveness and profitability of our members – by developing, executing and improving upon marketing strategies of various entities to build brand awareness and customer satisfaction and to drive web use, engagement, purchase and member/customer loyalty. Position manages marketing campaigns and projects.
|Field Service Representative l||
The Level I Field Service Representative is an entry level position reporting to the Field Service Rep Manager and is responsible for the enrollment, implementation and education of Western Growers Assurance Trust (WGAT) health benefit plan participants, including response to customer requests and questions concerning health benefits, eligibility, and benefit claim questions. Additionally, the Field Service Representative is responsible for servicing WGAT participants by analyzing and rectifying customer concerns using established procedures and protocol.