Implementation Auditor

Western Growers

Implementation Auditor at Pinnacle Claims Management performing plan coding and testing for health insurance compliance. Focused on operational efficiencies and collaboration for health benefit solutions.

Posted 4/29/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $45,091 - $63,617 per yearWebsite

About the role

Key responsibilities & impact

Perform in-depth plan coding and testing of new and existing business accounts
Ensure compliance with the respective employers’ summary plan descriptions for health insurance plans
Verify new and existing plans loaded on the Company’s claim management system against the appropriate Summary Plan Description
Test all new plans prior to loading them into production
Work with programmers to test claims and related system programs
Communicate with other operational departments to ensure smooth integration of new plans
Provide monthly reporting of all requested plan issues submitted from the Claims department
Identify inefficiencies within established processes and suggest solutions
Create and document Standard Operating Procedures (SOP)
Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data

Requirements

What you’ll need

BS/BA degree in Business or related field
minimum of three (3) to (5) 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
Knowledge of medical terminology
Familiar with ICD10, CPT, HCPC, and CDT codes.

Benefits

Comp & perks

affordable health benefit solutions
flexible work arrangements with work-from-home, in-office or hybrid options
competitive compensation packages
premier investment support
enriching personal development
profit-sharing

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

plan codingplan testingclaims auditingHIPAA compliancedata analysisSOP documentationICD10 codingCPT codingHCPC codingCDT coding

Soft Skills

problem-solvingcommunicationinterpersonal skillsorganizationattention to detailwriting skillsediting skillsproofreading skillsmulti-taskingdecision-making