Coder

Western Growers

Coder for pharmacy and medical plan managing compliance at Pinnacle Claims Management. Ensures accuracy in claims payments and enhances service for self-funded companies.

Posted 4/29/2026full-timeRemote • 🇺🇸 United StatesJuniorMid-Level💰 $44,669 - $65,668 per yearWebsite

About the role

Key responsibilities & impact

plan code new business and plan changes
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
respond to work orders received from examiners to investigate plan issues and irregularities
evaluate testing requests for all new plans prior to loading them into the production system
keep a detailed log of open and completed work
document resolutions to closed work orders
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
maintain detailed log of plans that are currently being coded and in the process of being loaded
send confirmations to internal stakeholders when applicable plans have been loaded
work with programmers to test claims and related system programs to verify impact within the Health Care Processing System (HCPS)
utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members

Requirements

What you’ll need

BS/BA degree in computer science, business or related field
minimum of two years of experience as a pharmacy, medical, dental claims auditor and/or plan testing experience, preferred
exceptional ability to interpret summary plan descriptions of employee medical, dental, pharmacy 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
excellent writing, editing, and proofreading skills to compose and edit correspondence, reports, emails, and other written materials
superior ability to analyze and interpret group health benefits provisions, administrative policies, and provider contracts
advanced skills in Microsoft Office applications, specifically word processing and spreadsheets
demonstrated ability to analyze and comprehend complex issues, and personalities using independent judgment, leadership, tact, diplomacy, and initiative

Benefits

Comp & perks

affordable health benefit solutions
flexible work arrangements
competitive compensation packages
profit-sharing

ATS Keywords

✓ Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

claims auditingplan testingprocess improvementdata analysisdocumentationStandard Operating Procedure (SOP) creationproblem-solvingefficiency identificationrisk reductioncost reduction

Soft Skills

communicationwritingeditingproofreadingleadershiptactdiplomacyinitiativeindependent judgmentmulti-tasking