Plan Coder

JOB DESCRIPTION

SUMMARYPosition reports to the Supervisor Benefit Distribution & Installation and performs in-depth pharmacy and medical plan coding of new and existing business accounts. This position will ensure that all new and existing health (medical / dental / pharmacy) insurance plans underwritten by Western Growers Assurance Trust (WGAT) and those of Pinnacle Claims Management, Inc. (PCMI) are in compliance with the respective employers’ summary plan descriptions. Qualifications

• BS / BA degree in computer science, business or related field and a minimum of two years of experience as a pharmacy, medical, dental claims auditor and / or plan testing experience,preferred.
• Exceptional ability to interpret summary plan descriptions ofemployee medical, dental, pharmacybenefits.
• Strong ability to work efficiently and effectively in a multiple task, multi-project, and multi-demanding environment to meet expected goals, dates, and milestones.
• Excellent writing, editing, and proofreading skills to compose and edit correspondence, reports, emails, and other written materials.
• Superior ability to analyze and interpret group health benefits provisions, administrativepolicies, and providercontracts.
• Advanced skills in Microsoft Office applications, specifically word processing and spreadsheets.
• Demonstrated ability to analyze and comprehend complex issues, and personalities using independent judgment, leadership, tact, diplomacy, and initiative
• 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 (., facing computer towards wall,
• A functioning smoke detector, fire extinguisher, and first aid kit on site.

DUTIES AND RESPONSIBILITIES

Plan Coding

Administrative

Other