Installation and Benefits Process Analyst

Description

If you're looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we're looking for you.

At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full-suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees.

As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn't a work life and a home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee's life. One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options.

With competitive compensation packages, premier investment support, enriching personal development and more, we strive for our employees' job satisfaction and success.

Compensation: $66,144 - $68,128 with a rich benefits package that includes profit-sharing.

JOB DESCRIPTION SUMMARY

The Installation and Benefit Process Analyst is responsible for a full range of activities, which ensure operational effectiveness, and excellence of benefit and business set-up for new and renewing health benefit plans. This is a key position within the Installation and Claims Operations Department and is vital to its ongoing success. The Analyst will design, document, and refine workflows, offering recommendations to enhance operational effectiveness. Additionally, the Analyst will track, analyze, and report on health plan operational trends, while leading key departmental projects. Acting as the liaison, the Analyst will collaborate with various departments (Claims, Audit, Reinsurance, Installation, Customer Service, Information Services, Sales, Account Management and Distribution).

QUALIFICATIONS

• BA/BS degree in business, health care, computer science and three (3) years of eligibility and benefit in health insurance operations or six (6) years of experience working in a related field preferred.
• Exceptional in-depth knowledge of health benefit/insurance products and procedures including self-funded and fully insured products. Experience working with claims processing, customer service units and benefit plan structure and coding systems in a group health benefits operations environment.
• Advanced level of knowledge in the structure of groups, subgroups, and company benefit plans to ensure compliance with the Health Care Processing System for report generation purposes and data retrieval purposes.
• Effective project management skills and the ability to manage multiple projects.
• Ability to think analytically and solve complex problems.
• Ability to create and maintain project schedules by developing project plans and specifications, estimating time requirements, establishing deadlines, monitoring milestone completion, tracking all phases of the project lifecycle, providing timely reporting of issues that impact project progress, coordinating actions, and resolving conflicts.
• Ability to establish priorities, multi-task, work under pressure and tight deadlines, work independently with minimal supervision.
• Ability to transform requests and ideas into clearly written business requirements.
• Advanced computer skills in a variety of software applications including Microsoft Access, PowerPoint, Excel, Word, PowerPoint, Visio, and Outlook.
• Excellent written and oral communication skills.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
• Home router with wired Ethernet (wireless connections and hotspots are not permitted).
• A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
• A functioning smoke detector, fire extinguisher, and first aid kit on site.

DUTIES AND RESPONSIBILITIES

Installation

• Implement each new client/group with the third-party administrator (TPA) or the Multiple Employer Welfare Arrangement (MEWA) with necessary communication between the broker, operational areas, the client and any external vendor as necessary, including the review, completion & sign-off on Client Set-up forms/screens.
• Screen, review and process all new business, plan change & renewal paperwork for compliance purposes to include completeness, required forms, accuracy and content.
• Maintain familiarity with specific ongoing client needs and the processes required to fulfill those needs.
• Clarify end user requirements and build or work with the Information Services department to develop department/workflow solutions to improve efficiencies within the department.
• Assist department management in developing tactical and strategic products, services and/or programs to support the department's goals (financial, quality, production, customer service, operational efficiency, etc.).
• Test and validate new programs and products for compliance with department business requirements and validate results to management.
• Act as liaison with other departments to resolve Claim Operations and Installation related issues and intra-company workflow issues. Monitor business needs and create, develop, enhance, and document processes and procedures.

Training

• Train benefit distribution staff in department policies and procedures as necessary to maintain department and organizational standards and strategic objectives.
• Prepare management reports monthly including but not limited to presentation of data as well as identify trends and any items that fall below pre-established performance goals.

Documentation and Reporting

• Review, analyze, and create detailed documentation of business systems and user needs, including workflow, program functions, and steps required to develop or modify computer programs relative to claim operations and installation.
• Create report description as well as document operating procedures.
• Develop ad-hoc reports as needed to respond to department data and reporting needs.
• Analyze the department activities and trends and compare analysis against the service standards and best practices. Present findings and work with the department management to identify and implement strategies that will address tactical and strategic goals.

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 in a helpful and collaborative manner, being willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating positive impact, and being diligent in delivering results.
• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA[1]required protection of all confidential/protected client data.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).
• All other duties as assigned.

PHYSICAL DEMANDS/WORK ENVIRONMENT

The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodation 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 travel to both indoor and outdoor areas that can vary in exposure and temperature. The employee is frequently required to operate a motor vehicle, use objects, tools, or controls, and/or required to lift up to 50lbs. The noise level in the work environment is usually moderate.