Eligibility & Billing Specialist II

Western Growers Assurance Trust; Irvine (CA); On-site; USD 55,000 - 75,000; Full time

Job summary

Western Growers Assurance Trust is seeking an Eligibility Specialist II to process enrollment and billing tasks across WGAT and PCMI accounts. You will assist clients with eligibility management, explain billing issues, and resolve discrepancies while maintaining HIPAA-compliant data security.

The role requires accuracy, strong communication, and collaboration with internal teams and external partners; prior experience with EDI and healthcare eligibility is preferred.

Qualifications

• High School diploma or equivalent; 3–5 years accounting/business experience preferred.
• Knowledge of HIPAA, COBRA, Cal-COBRA and ERISA legislation.
• Proficiency with Microsoft Office (Word, Excel, Outlook).
• Experience handling health care eligibility and billing; strong customer service skills.

Responsibilities

• Process enrollment transactions (adds/changes/terminations) for multiple lines of business.
• Handle billing items, explain payments, and resolve discrepancies with clients.
• Perform cash application, account reconciliations, and refunds review.
• Maintain HIPAA-compliant workstation and data security; meet audit standards.
• Produce SOPs and suggest process improvements; assist training as needed.

Skills

Accounting knowledge

Customer service

Time management

Communication skills

Bilingual Spanish

Education

High School diploma or equivalent

Tools

Microsoft Office

HCPS processing system

EDI processing

Job description

Western Growers Assurance Trust is seeking an Eligibility Specialist II to process enrollment and billing tasks across WGAT and PCMI accounts. You will assist clients with eligibility management, explain billing issues, and resolve discrepancies while maintaining HIPAA-compliant data security.

The role requires accuracy, strong communication, and collaboration with internal teams and external partners; prior experience with EDI and healthcare eligibility is preferred.