If you’re looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we’re looking for you.               At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full-suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees.               As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn’t a work life and a home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee’s life. One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options.               With competitive compensation packages, premier investment support, enriching personal development and more, we strive for our employees’ job satisfaction and success.             
Compensation:$39,208- $55,972 with a rich benefits package that includes profit-sharing.

Job Description Summary

Under the direction of the Supervisor I, Key Accounts, the Field Operations Specialist I is responsible for the education of Key Accounts programs, performing education, enrollment, and claims processing functions necessary to maintain client accounts. This role will interface with external partners and vendors as they relate to client requests, as well as support clients in the office. The role is also responsible for providing the highest level of customer service support to clients by educating them on program guidelines as it relates to program eligibility and reimbursement issues.

Qualifications

• High school diploma or equivalent and one (1) to three (3) years of customer service and/or accounting/business experience with knowledge of generally accepted accounting procedures, analytical abilities, or equivalent combination of education and experience preferred.
• Knowledge of generally accepted health care eligibility and billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA) and Employee Retirement Income Security Act (ERISA) legislation.
• Excellent oral and written communication skills in English and Spanish, including modern business communications, formatting of professional letters, reports, and phone etiquette, required.
• Comprehensive command of the Spanish language with the ability to utilize it up to 50% of the time.
• Strong computer aptitude with Word, Excel, and Outlook and the ability to develop a strong proficiency working with a proprietary Health Care system.
• Experience providing Customer Service to a variety of client contacts via email and telephone.
• Strong ability to research and resolve technical issues or client problems as they arise with minimal direction.
• Proficient written and oral communication skills including an ability to present material effectively in person.
• Ability to establish priorities, multi-task, work under pressure and deadlines, and work independently with minimal supervision or in a team environment.
• General knowledge of health insurance operations and industry.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
• Home router with wired Ethernet (wireless connections and hotspots are not permitted).  
• A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)  
• A functioning smoke detector, fire extinguisher, and first aid kit on site.
• Verifiable, clean DMV record and the ability to travel to various locations throughout the U.S. (mainly California and Arizona) up to 50% of the time.

Duties And Responsibilities

Customer Service and Education Services

• Provide timely and effective customer service to clients for requests, inquiries, or issues concerning enrollment and reimbursement items on their accounts, in person, via email and via the phone.
• Provides support for overflow inbound calls as needed when not in the field.
• Interface effecti