Health Plan Implementation Auditor

Western Growers Health; Irvine (CA); On-site; USD 70,000 - 95,000; Full time

Job summary

Western Growers Health is seeking an experienced professional to perform in-depth plan coding and testing for health (medical/dental) insurance plans. The role ensures compliance with employer plan descriptions and coordinates with WGAT/PCMI in production readiness.

The candidate will test plans, develop SOPs, and maintain HIPAA-compliant practices while supporting ongoing process improvements and data security.

Qualifications

• Experience validating health insurance plans against plan descriptions.

Responsibilities

• Test new and existing health plans against Summary Plan Descriptions to ensure accuracy of claims.
• Verify plans before production loading and coordinate with programmers for impact testing.
• Produce monthly reports on plan issues and suggest process improvements.
• Create and document SOPs and support HIPAA-compliant workstation practices.

Skills

Plan testing

SOP development

HIPAA compliance

Job description

Western Growers Health is seeking an experienced professional to perform in-depth plan coding and testing for health (medical/dental) insurance plans. The role ensures compliance with employer plan descriptions and coordinates with WGAT/PCMI in production readiness.

The candidate will test plans, develop SOPs, and maintain HIPAA-compliant practices while supporting ongoing process improvements and data security.