[Remote] Financial Specialist II

Note: The job is a remote job and is open to candidates in USA. Western Growers Health, part of the Western Growers Family of Companies, provides employer-sponsored health benefit plans tailored for the agriculture industry. They are seeking a Financial Specialist II to manage financial transactions, maintain accounts receivables, and support various billing processes to ensure accurate financial operations.ResponsibilitiesMaintain/manage all Pinnacle Claims Management, Inc. (PCMI) contribution/premium reimbursements, COBRA/Retiree reimbursements, and vendor pass thru payments for PCMIVerify and authorize the release of PCMI vendor payment within four business days of account fundingManage the process of funding and releasing self-funded claims paymentsReconcile and maintain accuracy of group ledger accounts by matching incoming payments to corresponding invoices, promptly investigating and resolving discrepancies, collaborating with internal teams and external partners to make adjustments, and maintaining thorough documentation to support audit trailsMonitor bank accounts daily for returned items, overdrafts, positive pay exceptions, stop payments and other exception reporting and make decision for resolution or escalation. Month End Financials completed and delivered to Accounting by the fifth (5th) business day of the monthAssist with Mid-Month cash application audit that must be completed by the 15th business day of the monthManage and maintain Bank lockbox, and ACH/Wire programsManage and maintain retiree invoicing & receivable management program(s)Support FSA (Flexible Spending Account) HSA (Health Savings Account) HRA (Health Reimbursement Arrangement) programManage the delinquency process for both WGH & PCMI accountsManage the third-party pharmacy process by reviewing consumer claim data files from vendors and coordinating billing and invoicing between operational and accounting teams to ensure accurate and timely payments. Validate and audit pharmacy data files against contract pricing, documenting, and reporting findings. Additionally, ensure files are audited and loaded promptlyProcess and verify the necessary corrections on manual adjustments posted to group ledger on HealthCare Processing System for PCMI, Western Growers Health (WGH) and individual accounts (COBRA)/RetireePerform bank reconciliations for customer accounts and initiate ledger adjustments as neededVerify/authorize refund for terminations and overpayments on all accountsApply cash to appropriate ledgers and research /correct application issuesProvide back-up resource for invoice generation, daily cash application and other customer accounting dutiesProcess related written and verbal account inquiries to its conclusion in a timely manner to include research on as needed basisPrepare ad hoc reports upon requestProactively identify inefficiencies within established processes and recommend solutions to optimize time, reduce risk, and minimize cost. Contribute to process improvements and innovation by raising concerns and offering suggestions for enhancements and implementationCreate and document Standard Operating Procedures (SOP’s)Perform ledger reconciliations to ensure accuracy and compliance with financial recordsWork with Eligibility Specialists to research/resolve unpaid and/or outstanding balances for PCMI employer groups, and COBRA/Retiree accountsAct as a liaison to other departments for resolution of issues that may ariseProvide timely and effective customer service to clients by addressing requests, inquiries, and issues related to customer accountsServe as representative of PCMI and WGH displaying professionalism, knowledge, customer service and discretion in all interactions with other members of PCMI and WGH community and their customersGet curious and strive to understand others’ outside triangles, (what they are needing/wanting to do)Plan and execute work in a helpful and collaborative mannerBe accountable for helping assess and report performance in terms of impact, making improvements, and course correcting along the wayConsistently meet processing cycle time standards and production due datesMentor Customer Accounting Specialist IUtilize 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 resultsMaintain internet speed of 40 MB download and 10 MB upload and router with wired EthernetMaintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client dataMaintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit)All other duties as assignedSkillsBA/BS degree in accounting, finance, or business-related field and three (3) to five (5) years of experience working in a related field or equivalent combination of education and experience preferredSkills to establish priorities, multi-task, work under pressure and deadlines, work independently with minimal supervision or in team environmentProficient in Microsoft applications, including intermediate skills in Excel, Word, and OutlookExperienced in performing customer account reconciliations, including research, and resolving discrepancies with minimal supervisionExcellent written and oral communication skills, to include modern business communications, formatting professional letters, reports, and phone etiquetteCustomer service orientedAbility to analyze and resolve technical problems and/or client inquiries as they ariseKnowledge of generally accepted Health Care Eligibility and Billing procedures as well as Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), Cal-COBRA, Multiple Employer Welfare Arrangement (MEWA) and Employee Retirement Income Security Act (ERISA) regulationsKnowledge of health insurance industryAbility to work overtime as requested by management and based upon department needs and complianceInternet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speedsHome 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 siteBenefitsRich benefits package that includes profit-sharingCompany OverviewPinnacle Claims Management provides a spectrum of health benefits administration services to self-funded employers in all industries. It was founded in 1996, and is headquartered in Irvine, California, USA, with a workforce of 201-500 employees. Its website is https://www.pinnacletpa.com/.