Implementation Auditor

Summary

Western Growers Assurance Trust is seeking an Implementation Auditor to ensure compliance of health insurance plans. This role involves in-depth plan coding, testing of new and existing accounts, and collaboration with operational departments to integrate new plans.

Responsibilities

• Using close and comprehensive analyses, 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
• Test all new plans prior to loading them into production (medical, dental and vision plans)
• Work with programmers to test claims and related system programs to verify impact within the HCPS
• System analysis and testing of mass system updates
• Plan coding of new business and plan changes for medical, dental, and vision plans
• Communicate with other operational departments, as necessary, to ensure smooth integration of new plans for both WGAT and PCMI moving into production
• Provide monthly reporting of all requested plan issues submitted from the Claims department
• 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)
• Identify, initiate and implement process improvements and/or innovation
• 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 helpfully and collaboratively
• Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a 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-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

Skills

• In-depth plan coding and testing of new and existing business accounts
• Ensure compliance with respective employers' summary plan descriptions
• 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 (medical, dental and vision plans)
• Work with programmers to test claims and related system programs
• System analysis and testing of mass system updates
• Plan coding of new business and plan changes for medical, dental, and vision plans
• 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 possible solutions
• Create and document Standard Operating Procedures (SOP)
• Identify, initiate and implement process improvements and/or innovation
• Utilize all capabilities to enhance the competitiveness and profitability of members
• 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
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit)
• Perform all other duties as assigned

Qualifications

Must Haves

• In-depth plan coding and testing of new and existing business accounts
• Ensure compliance with respective employers' summary plan descriptions
• 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 (medical, dental and vision plans)
• Work with programmers to test claims and related system programs
• System analysis and testing of mass system updates
• Plan coding of new business and plan changes for medical, dental, and vision plans
• 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 possible solutions
• Create and document Standard Operating Procedures (SOP)
• Identify, initiate and implement process improvements and/or innovation
• Utilize all capabilities to enhance the competitiveness and profitability of members
• 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
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit)
• Perform all other duties as assigned