Strategic Health Plan Implementation Auditor

Western Growers Assurance Trust; Irvine (CA); On-site; USD 85,000 - 120,000; Full time

Job summary

Western Growers Assurance Trust is seeking a QA/Testing Specialist to verify and test health plans (medical/dental/vision) loaded to the claim system, ensuring compliance with summary plan descriptions. You will work with programming and operations to validate claims and produce monthly issue reports, while documenting SOPs and driving process improvements.

The role requires strong analytical and writing skills, experience with plan testing, and proficient use of Microsoft Office, with attention

Qualifications

• BS/BA in Business or related field with 3–5 years of relevant experience in medical/dental claims auditing or plan testing.
• Exceptional ability to interpret summary plan descriptions of benefits and responsibilities.
• Excellent writing, editing, and proofreading skills for formal correspondence and reports.
• Strong analytical mindset with attention to detail and the capacity to manage multiple tasks.

Responsibilities

• Perform in-depth plan coding and testing of new and existing health plans.
• Verify loaded plans against Summary Plan Descriptions to ensure accurate claims payments.
• Test all new plans prior to production for medical, dental, and vision plans.
• Collaborate with programmers to test claims and related system programs for impact.
• Produce monthly reports on plan issues and identify process improvements.
• Create and maintain SOP documentation and participate in process innovation.

Skills

Plan testing

System testing

HIPAA compliance

SOP documentation

Technical writing

Analytical skills

Communication skills

Microsoft Office

Attention to detail

Education

BS/BA in Business or related field

3-5 years medical/dental claims auditor or plan testing experience

Tools

Microsoft Office

Claim management system

Job description

Western Growers Assurance Trust is seeking a QA/Testing Specialist to verify and test health plans (medical/dental/vision) loaded to the claim system, ensuring compliance with summary plan descriptions. You will work with programming and operations to validate claims and produce monthly issue reports, while documenting SOPs and driving process improvements.

The role requires strong analytical and writing skills, experience with plan testing, and proficient use of Microsoft Office, with attention