{"schemaVersion":"jobsearcher.job.v1","id":"2d80c40a1fba2fb2bcb6cf08","url":"https://jobsearcher.com/jobs/2d80c40a1fba2fb2bcb6cf08","canonicalUrl":"https://jobsearcher.com/jobs/2d80c40a1fba2fb2bcb6cf08","title":"Implementation Auditor","description":"At Pinnacle Claims Management, an innovative third‑party administrator (TPA), we provide comprehensive and customized health benefits administration services for self‑funded companies, including health management, wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we prioritize the well‑being of our employees and offer flexible work arrangements such as work‑from‑home, in‑office, or hybrid options.\n\nCompensation: $45,091 - $63,617 with a rich benefits package that includes profit‑sharing.\n\nJob Description Summary\nThis role reports to the Supervisor, Benefit Installation & Distribution and performs in‑depth plan coding and testing of new and existing business accounts. The position ensures that all health (medical/dental) insurance plans underwritten by the Western Growers Assurance Trust (WGAT) and Pinnacle, Inc. (PCMI) are compliant with their summary plan descriptions.\n\nQualifications\n\nBS/BA degree in Business or related field and a minimum of 3–5 years of recent experience as a medical/dental claims auditor or plan testing experience, preferred.\n\nExceptional understanding of summary plan descriptions for employee medical/dental benefits.\n\nStrong ability to work efficiently and effectively in a multi‑task, multi‑project environment to meet goals, dates, and milestones.\n\nAbility to anticipate problems, recommend solutions, and exercise best judgement.\n\nExcellent writing, editing, and proofreading skills for correspondence, reports, and other materials.\n\nProficient analytical and interpretive skills for group health benefits provisions, administrative policies, and provider contracts.\n\nExperience with conducting research and presenting complex information.\n\nExcellent communication and interpersonal skills.\n\nSuperior organization skills and high attention to detail.\n\nAbility to learn complex business processes and apply knowledge to make informed decisions.\n\nAdvanced skills in Microsoft Office applications.\n\nKnowledge of medical terminology and familiarity with ICD‑10, CPT, HCPCS, and CDT codes.\n\nRequired home office setup: wired Ethernet router, designated room for work, functioning smoke detector, fire extinguisher, and first aid kit.\n\nDuties and Responsibilities\nTesting\n\nUse comprehensive analyses to verify new and existing plans loaded on the company’s claims management system against the appropriate summary plan descriptions to determine the accuracy of future claims payments.\n\nTest all new plans prior to loading them in production (medical, dental, and vision plans).\n\nCollaborate with programmers to test claims and related system programs to verify impact within the HCPS.\n\nConduct system analysis and testing of mass system updates.\n\nPerform plan coding for new business and plan changes for medical, dental, and vision plans.\n\nCommunicate with other operational departments to ensure smooth integration of new plans for both WGAT and PCMI moving into production.\n\nReporting\n\nProvide monthly reporting of all requested plan issues submitted from the Claims department.\n\nIdentify inefficiencies within established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.\n\nCreate and document Standard Operating Procedures (SOP).\n\nIdentify, initiate, and implement process improvements and/or innovations.\n\nOther\n\nUtilize all capabilities to enhance the competitiveness and profitability of our members. Strive to understand what others are trying to achieve, plan, and execute work helpfully and collaboratively.\n\nMaintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).\n\nAll other duties as assigned.\n\nPhysical Demands/Work Environment\nThe 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. The employee is regularly required to communicate with others, move around the office, and use tools and controls. The noise level in the work environment is usually moderate.\n\n#J-18808-Ljbffr","company":"Pinnacle Claims Management","rawCompany":"pinnacle claims management","city":"Irvine","state":"CA","isRemote":false,"isActive":false,"createdAt":"2026-04-09T08:05:28.124Z","occupations":[{"code":"13-1031.00","title":"Claims Adjusters, Examiners, and Investigators","slug":"claims-adjusters-examiners-and-investigators"},{"code":"43-9041.00","title":"Insurance Claims and Policy Processing Clerks","slug":"insurance-claims-and-policy-processing-clerks"},{"code":"51-9061.00","title":"Inspectors, Testers, Sorters, Samplers, and Weighers","slug":"inspectors-testers-sorters-samplers-and-weighers"}],"industries":[{"code":"524292","title":"Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds","slug":"pharmacy-benefit-management-and-other-third-party-administration-of-insurance-and-pension-funds"},{"code":"524298","title":"All Other Insurance Related Activities","slug":"all-other-insurance-related-activities"},{"code":"524114","title":"Direct Health and Medical Insurance Carriers","slug":"direct-health-and-medical-insurance-carriers"}],"jobPosting":{"@context":"https://schema.org","@type":"JobPosting","title":"Implementation Auditor","description":"At Pinnacle Claims Management, an innovative third‑party administrator (TPA), we provide comprehensive and customized health benefits administration services for self‑funded companies, including health management, wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we prioritize the well‑being of our employees and offer flexible work arrangements such as work‑from‑home, in‑office, or hybrid options.\n\nCompensation: $45,091 - $63,617 with a rich benefits package that includes profit‑sharing.\n\nJob Description Summary\nThis role reports to the Supervisor, Benefit Installation & Distribution and performs in‑depth plan coding and testing of new and existing business accounts. The position ensures that all health (medical/dental) insurance plans underwritten by the Western Growers Assurance Trust (WGAT) and Pinnacle, Inc. (PCMI) are compliant with their summary plan descriptions.\n\nQualifications\n\nBS/BA degree in Business or related field and a minimum of 3–5 years of recent experience as a medical/dental claims auditor or plan testing experience, preferred.\n\nExceptional understanding of summary plan descriptions for employee medical/dental benefits.\n\nStrong ability to work efficiently and effectively in a multi‑task, multi‑project environment to meet goals, dates, and milestones.\n\nAbility to anticipate problems, recommend solutions, and exercise best judgement.\n\nExcellent writing, editing, and proofreading skills for correspondence, reports, and other materials.\n\nProficient analytical and interpretive skills for group health benefits provisions, administrative policies, and provider contracts.\n\nExperience with conducting research and presenting complex information.\n\nExcellent communication and interpersonal skills.\n\nSuperior organization skills and high attention to detail.\n\nAbility to learn complex business processes and apply knowledge to make informed decisions.\n\nAdvanced skills in Microsoft Office applications.\n\nKnowledge of medical terminology and familiarity with ICD‑10, CPT, HCPCS, and CDT codes.\n\nRequired home office setup: wired Ethernet router, designated room for work, functioning smoke detector, fire extinguisher, and first aid kit.\n\nDuties and Responsibilities\nTesting\n\nUse comprehensive analyses to verify new and existing plans loaded on the company’s claims management system against the appropriate summary plan descriptions to determine the accuracy of future claims payments.\n\nTest all new plans prior to loading them in production (medical, dental, and vision plans).\n\nCollaborate with programmers to test claims and related system programs to verify impact within the HCPS.\n\nConduct system analysis and testing of mass system updates.\n\nPerform plan coding for new business and plan changes for medical, dental, and vision plans.\n\nCommunicate with other operational departments to ensure smooth integration of new plans for both WGAT and PCMI moving into production.\n\nReporting\n\nProvide monthly reporting of all requested plan issues submitted from the Claims department.\n\nIdentify inefficiencies within established processes and suggest possible solutions to save time, reduce risk, and/or reduce expenses.\n\nCreate and document Standard Operating Procedures (SOP).\n\nIdentify, initiate, and implement process improvements and/or innovations.\n\nOther\n\nUtilize all capabilities to enhance the competitiveness and profitability of our members. Strive to understand what others are trying to achieve, plan, and execute work helpfully and collaboratively.\n\nMaintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).\n\nAll other duties as assigned.\n\nPhysical Demands/Work Environment\nThe 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. The employee is regularly required to communicate with others, move around the office, and use tools and controls. The noise level in the work environment is usually moderate.\n\n#J-18808-Ljbffr","datePosted":"2026-04-09T08:05:28.124Z","dateModified":"2026-04-09T08:05:28.124Z","hiringOrganization":{"@type":"Organization","name":"Pinnacle Claims Management","sameAs":"https://jobsearcher.com"},"jobLocation":{"@type":"Place","address":{"@type":"PostalAddress","addressLocality":"Irvine","addressRegion":"CA","addressCountry":"US"}},"identifier":{"@type":"PropertyValue","name":"JobSearcher","value":"2d80c40a1fba2fb2bcb6cf08"},"url":"https://jobsearcher.com/jobs/2d80c40a1fba2fb2bcb6cf08"}}