Western Growers Family of Companies

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.. We are also a proud contracted partner with Covered California.. One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options.. Supports and advises clients and brokers on self-funding, pharmacy benefits management, care management and utilization review, wellness, stop loss and print and distribution.. Provides day-to-day administration and delivering of the needs of the clients and brokers as it relates to Pinnacle TPA and its ancillary products.

senior account manager

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. We are also a proud contracted partner with Covered California. 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: $79,349 - $114,167 with a rich benefits package that includes profit-sharing. Job Description Summary Position reports to Pinnacle Claims Management (PCMI) Director, Client Service and México Operations and coaches existing account management staff responsible for supporting customers, as well as is responsible for managing customer accounts during and following the sale of employer benefit programs and services including third party administration (TPA) health care benefits, complete ancillary benefits offered by PCMI vendor partners including Western Growers Insurance Services (WGIS) employer benefit programs. The Senior Account Manager working in collaboration with internal operation and administration departments will help coordinate and assist in "after-the-sale" implementation and plan support of the customer's account. Position also supports new sales expansion activities. Position helps in handling escalated account issues. Position grows existing account base by renewing contracts, uncovering new user groups, cross selling and upselling. This position is the critical link between internal service teams and business partnerships with customers. This position possesses strong analytical skills in account tracking. The Senior Account Manager provides the account management team with direction and an experience resource.Qualifications <ul><li>BA/BS and five to ten years of direct Account Management and service experience in TPA organization, employer health benefits, and employee health care benefits preferred. </li><li>Exceptional expertise working in a TPA and employer health benefits market and its relative services, policies, common practices, and procedures.</li><li>Demonstrated skill in health plan analysis and ability to present recommendation to clients/brokers.</li><li>Considerable knowledge of Pharmacy Benefit Manager (PBM) operations and customer care, preferred.</li><li>Significant knowledge of Wellness and Disease Management programs, preferred.</li><li>Thorough knowledge of ACA and federal benefit laws, practices and duties performed with little to no supervision.</li><li>Experience with major accounts and strong understanding of various funding vehicles available to large employers required.</li><li>Demonstrated strong relationship management experience with knowledge and experience in the area of benefit consultation and strategic planning.</li><li>Advanced personal computer operation skills in various software applications including word processing, spreadsheet, electronic mail and presentation.</li><li>Considerable composition and writing skills including grammar, spelling and proper use of punctuation.</li><li>Excellent verbal, written and presentation communication skills suitable for executive audiences with the ability to maintain strict confidentiality on matters relating to protected health care information.</li><li>Excellent organization skills, attention to detail with high degree of accuracy, and the ability to work independently and exercising judgment.</li><li>Ability to meet deadlines under pressure.</li><li>Ability to analyze information and evaluate results to choose the best solution.</li><li>Active Life & Health insurance license in California.</li><li>Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. (mainly California and Arizona) up to 30% of the time.</li><li>Strong category and relationship management skills with experiences in managing and working with Vendors and Service Providers.</li><li>Excellent business acumen and commercial skills including negotiation skills, both tactically and strategically.</li><li>Strong leadership, coaching, organizing, project management and communication skills.</li></ul>Duties And Responsibilities Account Management <ul><li>Evaluate and plan account management assignments to make the most efficient use of internal operation and administration team strengths and weaknesses to ensure client delivery commitments are met.</li><li>Provide strategic, consultative support to brokers and clients.</li><li>Identify strong internal and external vendor talent and best practices to ensure client satisfaction and future renewals. </li><li>Aid in preparation of Account Management department's annual budget based on book of business, expectations to retain and grow. </li></ul><ul><li>Supports and advises clients and brokers on self-funding, pharmacy benefits management, care management and utilization review, wellness, stop loss and print and distribution.</li></ul><ul><li>Conduct regular employer client process analysis focusing on opportunities to drive results such as process improvements, expectations management, key issues and resolutions.</li><li>Utilize broad knowledge of health and wellness employee benefits to instill confidence with decision makers and key stakeholders during service interactions. </li><li>Update job knowledge by participating in educational opportunities, reading professional publications, maintaining personal networks, and participating in professional organizations.</li><li>Accomplish organization goals by accepting ownership for accomplishing new and different requests, and exploring opportunities to add value to job accomplishments.</li><li>Responsible for the overall servicing of the overall book of business under the PCMI platform.</li><li>Provides day-to-day administration and delivering of the needs of the clients and brokers as it relates to Pinnacle TPA and its ancillary products.</li><li>Manage client relationships and promote timely resolution of client issues. Interface with appropriate departments and orchestrate resources to handle customer service issues.</li><li>Maintains client reference file on server for all assigned accounts, detailing past work, and work in-progress, and all pertinent information as it relates to the meeting of customer's/broker's needs.</li><li>Monitors projects to ensure they proceed according to plan, deadlines, and identifying potential problems before they occur.</li><li>Implement renewal and retention strategy for all clients by extracting key information, discussing current and prospective client operations, and presenting informed recommendations for health and ancillary benefits renewal action to brokers and clients.</li><li>Develop an understanding of PCMI system tools including PERC/WERC/Healthview/BusinessEdge/Deerwalk and HCPS operating systems. </li><li>Keep current on new laws and regulations that impact the medical insurance industry (continuing education/seminars). </li></ul> Upselling and Cross-sell <ul><li>Conducts analysis of reporting relative to claims history, pharmacy spend, chronic disease, etc. and determines if the clients' health plans may be more successful in conjunction with PCMI ancillary products.</li></ul><ul><li>Strategize and collaborate with Sales in an effort to sell additional Pinnacle products to create additional revenue for PCMI.</li><li>Prior to renewal, work with brokers to identify opportunities to focus such efforts on.</li><li>Prepare and present financial analysis on claims data for health, pharmacy and ancillary products; recognizing trends and cost drivers.</li><li>Coordinates with other internal departments to generate customer specific proposals on our PCMI offerings.</li><li>Understands the competitive landscape to effectively position PCMI products.</li></ul> Training and Leadership Support <ul><li>Continuous review and implementation of process improvements.</li><li>Train the Account Management team on department policies and procedures as necessary to maintain department and organizational standards and strategic objectives.</li><li>Train new Pinnacle employees relative to Account Management protocols, workflows and a general understanding of the department.</li></ul><ul><li>When appropriate, join onsite client reviews with Account Management team members. Provide input for documentation updates and enhancements, system enhancements and process improvement to ensure accuracy and effectiveness of strategies to drive increased team and organizational performance. </li><li>Establish clear defined goals and objectives. Communicate with department management through department meetings.</li><li>Contribute to the development or refining of work processes in order to improve efficiency and effectiveness.</li><li>Facilitate distribution of work between team members to assist during high volume periods.</li></ul> Other <ul><li>Be curious and strive to understand others' outside triangles (what they are needing/wanting to do). </li><li>Plan and execute work in a helpful and collaborative manner.</li><li>Be accountable for actually helping, assess and report performance in terms of impact, making improvements, and course correcting along the way.</li><li>Maintain a clean DMV record and the ability to travel to locations throughout the U.S. (mainly California and Arizona) up to 30% of the time. </li><li>All other duties as assigned.</li></ul>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 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.

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