Western Growers Health─ a part of Western Growers Family of Companies─provides employer-sponsored health benefit plans to meet the needs of those working for the agriculture industry. The unmatched benefit options provided by Western Growers Health stem from the core mission of Western Growers Association (est. 1926) to support the business interests of employers in the agriculture industry.

Our mission at Western Growers Health is to deliver value to employers by offering robust health plans that meet the needs of a diverse workforce. By working at Western Growers Health, you will join a dedicated team of employees who care about offering quality health benefits and excellent customer service to plan participants. If you want to start making a difference working in the health care industry, then apply to Western Growers Health today!    Compensation:  $81,624.24 - $106,110.27 with a rich benefits package that includes profit-sharing.  

Job Description Summary

Reporting to the Sr. Manager, Claims and Workforce Management, this role is responsible for overseeing the daily operations of the Customer Service Specialist team. This position ensures service delivery meets Key Performance Indicators (KPI’s), related to customer satisfaction, response times and providing quality service.  Responsibilities include recruiting, onboarding and staff development. This role also delivers focused operational support for enterprise accounts, ensuring timely and accurate execution of claims, eligibility and health management activities.

Qualifications

• BS/BA degree and a minimum of three (3) to five (5) years of recent experience as a supervisor of a medical/dental claims operation preferred.
• Subject matter expertise in medical, dental, Flexible Spending Account (FSA), Health Reimbursement Account (HRA) claim processing principles, and procedures.
• Strong understanding of electronic claim transactions (EDI) and healthcare code sets (CPT, HCPCS, ICD10 & revenue codes) across commercial plans, including MEWA, ERISA-based, and self-funded plans.
• Ability to interpret provider contracted rates, including letters of agreement, and apply them to the claim adjudication.
• Experience with call center operations, including statistical analysis and reporting preferred.
• Experience monitoring customer interactions and analyzing information to make informed business decisions.
• Working knowledge of PBM operations, including formulary management, pharmacy claims adjudication, prior authorization processes, and drug utilization review preferred.
• Strong understanding of regulatory requirements, including ACA, HIPAA, ERISA and COBRA.
• Excellent written and verbal communication, multi-tasking, research, and problem-solving skills.
• Demonstrated ability to work collaboratively in a team environment, facilitate meetings, conduct training sessions, and support team decisions.
• Proven ability to coach, mentor and develop employees, including delivering constructive performance feedback .
• 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.   

Duties And Responsibilities

Management & Leadership

• Develop, manage, and lead a high performing team of 3A+ self-accountable professionals.
• Develop a culture of authentic, personal accountability by modeling the behavior that defines it.
• Instill a culture of safety and expectation within your respective area/s.
• Require direct reports to hold themselves accountable to high-performance standards and personal conduct in a clear, helpful, straightforward way.
• Conduct one-on-one conversations with every direct report, focused on their 3A+ capabilities, impact, and effort.
• Make decisions impacting staff using the steps outlined in the “Outward Leadership” guide.
• Promote a culture of inclusion leveraging the “Outward Inclusion” principles.

Department Operations

• Generate and analyze routine reporting for call center, claims and health management.
• Monitor real-time service levels to ensure performance goals are met.
• Coordinate with Workforce Management to allocate time for non-call tasks and responsibilities.
• Identify staff training needs, support tr