Installation Auditor (50574)

Job Description Summary

The Installation Auditor ensures accurate setup of new and renewing health benefit plans by auditing documentation for compliance with Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management, Inc (PCMI). This role also acts as the installation project coordinator, overseeing new business installations from submission to completion, ensuring timely and accurate implementation. Key responsibilities include evaluating workflows, identifying process improvements, and leading projects to enhance operational efficiency. Acting as liaison, the Auditor will collaborate with various departments (Claims, Audit, Reinsurance, Installation, Customer Service, Information Services, Sales, Account Management and Distribution).

Duties And Responsibilities

Audit

• Audit the submissions for each new client/group with the third-party administrator (TPA) or the multiple employer welfare arrangements (MEWA).
• Audit all plan changes and renewal paperwork for compliance, completeness, required forms, accuracy and content.
• Conduct pre-installation audits to determine if new systems or programs developed or under development will work as planned.
• Act as liaison between cross functional departments to handle and direct intra-company workflow issues and develop new or enhanced processes and procedures.
• Test and validate new programs and products for compliance with department business requirements and validate results to management.

Reporting

• Maintain management reports daily to provide updates on business setup and renewing health plans
• Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.
• Create and document Standard Operating Procedures (SOP's).
• Identify, initiate and implement process improvements and/or innovation.

Other

• Utilize all capabilities to satisfy one mission - to enhance the competitiveness and profitability of our members. This job exists to serve directly (or indirectly) to someone in the fresh produce industry. 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 at least 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 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 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.