Health Plan Implementation Auditor

Western Growers Assurance Trust; United States; Remote; USD 60,000 - 85,000; Full time

Job summary

Western Growers Assurance Trust seeks a detail-oriented professional to perform in-depth plan coding and testing, ensuring medical, dental, and vision plans align with employers' Summary Plan Descriptions and HIPAA requirements. Responsibilities include validating claims data, testing new plan loadings, and documenting SOPs while collaborating with IT and operations to improve processes.

The role emphasizes compliance, thorough testing, and effective communication across departments to ensure

Qualifications

• BS/BA in Business or related field expected.
• Experience interpreting summary plan descriptions helpful.
• Ability to analyze benefits provisions and contracts.

Responsibilities

• Test and verify new and existing medical/dental plans against Summary Plan Descriptions.
• Test plans before production loading (medical, dental, vision).
• Collaborate with programmers to test claims and related system programs.
• Perform system analysis and testing of mass updates.
• Create and document SOPs and identify process improvements.
• Maintain HIPAA compliance and protect confidential data.
• Produce monthly reports on plan issues from Claims dept.

Skills

Attention to detail

Written communication

Interpersonal skills

Organization

Microsoft Office

Medical terminology

ICD10 CPT HCPC CDT codes

Analytical thinking

Research & presentation

Education

BS/BA degree in Business or related field

Tools

Microsoft Office applications

Job description

Western Growers Assurance Trust seeks a detail-oriented professional to perform in-depth plan coding and testing, ensuring medical, dental, and vision plans align with employers' Summary Plan Descriptions and HIPAA requirements. Responsibilities include validating claims data, testing new plan loadings, and documenting SOPs while collaborating with IT and operations to improve processes.

The role emphasizes compliance, thorough testing, and effective communication across departments to ensure