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: $38,625.60 - $48,750 with a rich benefits package that includes profit-sharing.

Job Description Summary

Under the direction of the Senior Supervisor, Customer Service, the bilingual Child Care Providers United (CCPU) customer service representative provides consultive telephonic and web-based assistance to Child Care Providers, Agents, and Enrollment Specialists in the Health Benefits Exchange administration. In addition, the incumbent will provide customer service support to individuals by instructing them on correct eligibility management procedures and troubleshooting application issues and concerns. This position is also responsible for responding to general customer inquiries regarding insurance benefits, provider contracts, eligibility, and claims in a confidential, professional, and ethical manner.

Qualifications

High School diploma or GED and a minimum of one (1) to three (3) years of experience in customer service within a call center environment preferred.
Excellent oral and written communication skills in English and Spanish, required.
Comprehensive command of the Spanish language with the ability to utilize it up to 35% of the time.
Knowledge of Health Benefits, eligibility, application, and enrollment processes preferred.
Knowledge of government regulations, federal states, and local health benefits programs preferred.
Good communication and telephone skills with a clear and concise speaking voice.
Demonstrated ability to learn new software and navigate multiple systems at once.
Moderate computing and keyboarding skills, including proficiency with Customer Relationship Management (CRM) software.
Ability to retain and apply knowledge of the various operations, products, and services of the organization, to provide excellent customer service support.
Ability to adapt to a constantly changing environment.
Proficient organizational and time management skills.
Ability to retain and apply knowledge of the various operations of the organization, products, and services to provide excellent customer service support.
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.

Duties And Responsibilities

Customer Advocate

Foster and build good working relationships with Providers, Agents, Certified Enrollment Counselors, and federal and state agency contacts.
Respond to customer questions telephonically or in writing regarding insurance benefits, provider contracts, eligibility, and claims confidentially, professionally, and ethically.
Research and resolve aged customer service open calls within company standards.
Obtain and extract information from the Health Care Processing System (HCPS) and other systems.
Develop and maintains positive customer relations and coordinate with various departments to ensure customer requests and questions are handled appropriately and promptly.
Be accountable and resolve issues by measuring impact, improving, and correcting course.
Adhere to the call center’s quality assurance guidelines to ensure best-in-class service is provided during all interactions.

Call Center Support

Thoroughly document information, activities, inquiry outcomes, and changes in the database for accurate tracking and analysis.
Research and analyze data to address operational challenges and customer service issues.
Provide external and internal customers with the requested information.
Communicate with the appropriate departments and identifies service issues.
Identify inefficiencies within the established processes and suggest possible solutions to save time, reduce risk, and reduce expenses.
Meet and maintain all KPIs to support the department service metrics and performance objections.

Other

Maintain regular attendance per employee handbook guidelines.
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.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. 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 move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.

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