Job Description

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:$53,667.86- $74,768.32 with a rich benefits package that includes profit-sharing.

The Customer Accounting Specialist II supports the financial and accounting activities of the Third-Party Administrator (TPA) by managing invoices, reconciliation, reporting, and coordination with internal and external stakeholders. This role ensures financial accuracy and compliance while acting as a key liaison between Finance, Accounting, and the Business teams. The incumbent is also responsible for managing check returns, NSF items, stale-dated payments, and supporting enrollment audits and payment follow-ups.  

Qualifications

• BA/BS degree in Accounting, Finance, Business Administration, or a related field, along with three (3) to four (4) years of experience in accounting, billing, or reconciliation within a health benefits, TPA, insurance, or healthcare services setting preferred.
• Strong understanding of health benefits billing processes, enrollment/eligibility data management, and carrier payment reconciliation.
• Proficiency in Microsoft Excel, financial reporting, and ability to work with proprietary accounting or benefits administration systems.
• Excellent written and oral communication skills, including the ability to produce professional reports and correspondence.
• Strong analytical skills with the ability to identify root causes of discrepancies and recommend corrective actions.
• Proven ability to work independently and collaboratively in a remote environment that meets company security and compliance requirements.
• Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds. (This language is needed as part of the job requirements only if the position is 100% remote or hybrid. Please remove language if this position does not meet this criterion.)  
• 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

Billing, Invoicing and Accounting Operations

• Serve as the primary point of contact between Key Accounts Operations and Accounting/Finance for financial questions and resolution of issues.
• Create, validate, and distribute client and vendor invoices in accordance with contracts and established billing cycles.
• Execute monthly billing processes; validate amounts, ensure proper allocations, and correct discrepancies prior to distribution.
• Maintain financial records including W-9 forms, billing documentation, contracts, and vendor account files.
• Evaluate existing financial and reconciliation processes for gaps or inefficiencies; design and recommend improvements, internal controls, or automation opportunities.
• Prepare data-driven presentations and reports for leadership, highlighting financial performance, operational efficiencies, and areas for corrective action.

Financial Reporting and Reconciliation 

• Analyze billing, payment, and enrollment data to identify trends, anomalies, or risks; provide actionable insights and recommendations to leadership.
• Generate regular and ad-hoc financial reports related to billing, payments, vendor remittances, and client activity.
• Maintain financial records including W-9 forms, billing documentation, contracts, and vendor account files.
• Participate in program financial audits, provide relevant documentation and reports.
• Collaborate with Reporting team to create and design necessary program and department financial reports to track operations spend to budget.
• Develop financial projections, scenario analyses, and forecasting models to support budgeting, program planning, and decision-making.
• Facilitate monthly meetings with department leaders to review financials, propose efficiencies, and assess vendor payment inconsistencies needing follow up.
• Perform monthly, quarterly, and annual account and member enrollment reconciliations; calculate, identify and resolve variances in payments, remittances, enrollments, and invoice applications.
• Analyze and audit enrollment data to validate accuracy of premium billing and remittances; collaborate with eligibility teams to correct inconsistencies.
• Investigate and process stale-dated checks, returned payments, and NSF transactions, coordinate follow-up and resolution.

Other

• Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.

 

• Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet
• Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data.
• Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit
• All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.