Claims Auditor

Western Growers celebrates more than 80 years of serving the fresh produce industry in California and Arizona. Our association members are the farmers who grow, pack and ship nearly one half of the nation's fresh vegetables, fruits and nuts. Some of the services we provide to our members include: health benefits, government relations, community relations, training, transportation claims and negotiations, legal and labor relations, financial services and retirement benefits, and property and casualty coverage.

 

Western Growers has 2 new openings in the Audit Reinsurance Department for a Claims Auditor.  Reporting to the Audit Reinsurance Supervisor, this position is and performs in-depth audits to ensure existing health (medical/dental) insurance plans, underwritten by The Trust, are congruent to the respective employers? summary plan descriptions.

 

The qualifications we are looking for are:

 

? BS/BA degree in business administration, or related field preferred and a minimum of three years of recent experience as a medical/dental claims auditor and/or plan tester and three years experience processing group health claims.

? Knowledge of CPT/ICD-9 and medical terminology.

? Exceptional understanding and interpretation of SPDs; of employee medical/dental benefits programs;

? Ability to analyze and interpret group health benefits provisions, administrative policies and provider contracts. 

? Must have well to excellent word-processing and spreadsheet skills.

 

 The duties and responsibilities of the position:

 

? Audit existing plans that are loaded on the Company?s claims system against the Summary Plan Description to determine the accuracy of claims payments, including high dollar/stop loss claims.

? Meet and exceed audit productivity standards.

? Responsible for preparing error reports and daily reconciliation.

? Review error trend reports and participate in rebuttal process for continuous improvement; providing feedback to the auditors and claim examiners.

? Provide one-on-one training to claim examiners.

? Run, analyze and distribute quarterly audit for the Trustee meeting

? All other duties as assigned.

 

Western Growers offers an extensive benefits package which includes competitive salaries, a wide selection of benefits including a flex dollar credit amount to purchase benefits, excellent 401K and pension plan, education reimbursement programs and an on-site gourmet cafeteria. Are your skills and qualifications a match?  If so, we?d love to hear from you!!! Please send your resume and salary history to hr@wga.com and reference Claims Auditor in the Subject Line.