Health Plan Implementation & Testing Auditor

Western Growers; Irvine (CA); On-site; USD 65,000 - 90,000; Full time

Job summary

Western Growers in Irvine, CA is seeking a detail-oriented Claims Auditor/Plan Tester to ensure health plans comply with SPDs and that claims are processed accurately. The role focuses on in-depth plan coding and testing for WGAT and PCMI, with collaboration across Claims and IT to validate plan changes before production.

You will develop SOPs, drive process improvements, and maintain HIPAA-compliant workflows while handling confidential data.

Qualifications

• BS/BA degree in Business or related field; 3–5 years in medical/dental claims auditing preferred.
• Strong ability to interpret summary plan descriptions of employee medical/dental benefits.
• Ability to manage multiple tasks and meet deadlines in a dynamic environment.
• Excellent writing, editing, and proofreading skills for reports and correspondence.
• Proficient in Microsoft Office applications.
• Knowledge of medical terminology and coding (ICD10, CPT, HCPCS, CDT).

Responsibilities

• Verify plans on the claim management system against SPDs to determine accuracy of claims payments.
• Test all new medical, dental, and vision plans prior to production.
• Collaborate with programmers to test claims and related system programs.
• Perform system analysis and testing of mass system updates.
• Code new business and plan changes for medical, dental, and vision plans.
• Provide monthly reporting of plan issues from Claims.
• Identify inefficiencies and suggest improvements to reduce risk and cost.
• Create and document Standard Operating Procedures (SOP).
• Identify and implement process improvements and innovation.
• Maintain HIPAA-compliant workstation and protect confidential data.
• Maintain and service safety equipment on site.

Skills

Attention to detail

Analytical thinking

Communication skills

Microsoft Office proficiency

Education

BS/BA degree in Business or related field

Tools

ICD10, CPT, HCPCS, CDT codes

Job description

Western Growers in Irvine, CA is seeking a detail-oriented Claims Auditor/Plan Tester to ensure health plans comply with SPDs and that claims are processed accurately. The role focuses on in-depth plan coding and testing for WGAT and PCMI, with collaboration across Claims and IT to validate plan changes before production.

You will develop SOPs, drive process improvements, and maintain HIPAA-compliant workflows while handling confidential data.