Pinnacle Claims Management · 2 months ago
Financial Specialist II
United States
Full-time
Remote
Mid Level
$54K/yr - $75K/yr
3+ years expPinnacle Claims Management is part of Western Growers Family of Companies, providing employer-sponsored health benefit plans for the agriculture industry. The Financial Specialist II will be responsible for processing financial transactions, maintaining accounts receivables, and managing vendor payments to ensure accurate and timely financial operations.
Employee BenefitsHealth CareInsurance
Responsibilities
Maintain/manage all Pinnacle Claims Management, Inc. (PCMI) contribution/premium reimbursements, COBRA/Retiree reimbursements, and vendor pass thru payments for PCMI
Verify and authorize the release of PCMI vendor payment within four business days of account funding
Manage the process of funding and releasing self-funded claims payments
Reconcile and maintain accuracy of group ledger accounts by matching incoming payments to corresponding invoices, promptly investigating and resolving discrepancies, collaborating with internal teams and external partners to make adjustments, and maintaining thorough documentation to support audit trails
Monitor bank accounts daily for returned items, overdrafts, positive pay exceptions, stop payments and other exception reporting and make decision for resolution or escalation. Month End Financials completed and delivered to Accounting by the fifth (5 th ) business day of the month
Assist with Mid-Month cash application audit that must be completed by the 15 th business day of the month
Manage and maintain Bank lockbox, and ACH/Wire programs
Manage and maintain retiree invoicing & receivable management program(s)
Support FSA (Flexible Spending Account) HSA (Health Savings Account) HRA (Health Reimbursement Arrangement) program
Manage the delinquency process for both WGH & PCMI accounts
Manage the third-party pharmacy process by reviewing consumer claim data files from vendors and coordinating billing and invoicing between operational and accounting teams to ensure accurate and timely payments. Validate and audit pharmacy data files against contract pricing, documenting, and reporting findings. Additionally, ensure files are audited and loaded promptly
Process and verify the necessary corrections on manual adjustments posted to group ledger on HealthCare Processing System for PCMI, Western Growers Health (WGH) and individual accounts (COBRA)/Retiree
Perform bank reconciliations for customer accounts and initiate ledger adjustments as needed
Verify/authorize refund for terminations and overpayments on all accounts
Apply cash to appropriate ledgers and research /correct application issues
Provide back-up resource for invoice generation, daily cash application and other customer accounting duties
Process related written and verbal account inquiries to its conclusion in a timely manner to include research on as needed basis
Prepare ad hoc reports upon request
Proactively identify inefficiencies within established processes and recommend solutions to optimize time, reduce risk, and minimize cost. Contribute to process improvements and innovation by raising concerns and offering suggestions for enhancements and implementation
Create and document Standard Operating Procedures (SOP’s)
Perform ledger reconciliations to ensure accuracy and compliance with financial records
Work with Eligibility Specialists to research/resolve unpaid and/or outstanding balances for PCMI employer groups, and COBRA/Retiree accounts
Act as a liaison to other departments for resolution of issues that may arise
Provide timely and effective customer service to clients by addressing requests, inquiries, and issues related to customer accounts
Serve as representative of PCMI and WGH displaying professionalism, knowledge, customer service and discretion in all interactions with other members of PCMI and WGH community and their customers
Get curious and strive to understand others’ outside triangles, (what they are needing/wanting to do)
Plan and execute work in a helpful and collaborative manner
Be accountable for helping assess and report performance in terms of impact, making improvements, and course correcting along the way
Consistently meet processing cycle time standards and production due dates
Mentor Customer Accounting Specialist I
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, be self-accountable, create a positive impact, and be 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
Qualification
Required
BA/BS degree in accounting, finance, or business-related field and three (3) to five (5) years of experience working in a related field or equivalent combination of education and experience preferred
Skills to establish priorities, multi-task, work under pressure and deadlines, work independently with minimal supervision or in team environment
Proficient in Microsoft applications, including intermediate skills in Excel, Word, and Outlook
Experienced in performing customer account reconciliations, including research, and resolving discrepancies with minimal supervision
Excellent written and oral communication skills, to include modern business communications, formatting professional letters, reports, and phone etiquette
Customer service oriented
Ability to analyze and resolve technical problems and/or client inquiries as they arise
Knowledge of generally accepted Health Care Eligibility and Billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), Cal-COBRA, Multiple Employer Welfare Arrangement (MEWA) and Employee Retirement Income Security Act (ERISA) regulations
Knowledge of health insurance industry
Ability to work overtime as requested by management and based upon department needs and compliance
Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds
Home router with wired Ethernet (wireless connections and hotspots are not permitted)
A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
A functioning smoke detector, fire extinguisher, and first aid kit on site
Benefits
Rich benefits package
Profit-sharing
Company
Pinnacle Claims Management
Pinnacle Claims Management provides a spectrum of health benefits administration services to self-funded employers in all industries.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Terry W.
Executive Assistant to the President and Chief Operating Officer
Recent News
2024-11-20
Company data provided by crunchbase