Implementation Auditor

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🕒 April 29

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Western Growers

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1926

🌾 Agriculture

📋 Compliance

Agriculture • Insurance • Compliance

Western Growers is an organization dedicated to supporting family farmers in Arizona, California, Colorado, and New Mexico who grow fresh produce. They provide a comprehensive range of services to enhance the economic outlook of farmers, protect their farmworker partners, and maintain a commitment to producing and supplying fresh, healthy produce. Western Growers advocates for fair legislation and regulations that benefit the agricultural community and offers innovative risk management solutions through their insurance services. Additionally, they engage in food safety, sustainable resource management, and offer a variety of educational and advocacy resources to support their members and the broader agriculture industry.

📋 Description

• 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

• 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

• 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