Pinnacle Claims Management, Inc. (PCMI) is a third party administrator that provides health benefits administration services to companies and organizations in all industries that self-fund their health insurance. We administer benefits to a diverse group of clients, including commercial and public entities, manufacturing firms and private businesses. We also provide a full suite of complementary solutions that include health management and wellness services, pharmacy benefit management, general underwriting and stop-loss insurance, and print and transaction solutions. Pinnacle is independently owned and has more than 20 years of experience as a TPA in the health benefits industry. This gives us the ability to provide recommendations for ways employers can maximize benefit utilization and save a significant amount in health care costs.

Description

Part of the Western Growers Family of Companies, Western Growers Assurance Trust (WGAT) was founded in 1957 to provide a solution to a need in the agricultural community — a need for employer-sponsored health benefit plans not previously available from commercial health insurance carriers. WGAT is now the largest provider of health benefits for the agriculture industry. The sponsoring organization of WGAT is Western Growers Association, created in 1926 to support the business interests of employers in the agriculture industry. WGAT’s headquarters is located in Irvine, California.

WGAT’s mission is to deliver value to agriculture-based employer groups by offering robust health plans that meet the needs of a diverse workforce. By working at WGAT, you will join a dedicated team of employees who truly 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 WGAT today!

Compensation: $51,853 - $72,409 with a rich benefits package that includes profit-sharing. This is a remote position and can reside anywhere in the U.S.

Job Description Summary

This position reports to the Manager, Operations Training. The incumbent is responsible for developing and facilitating learning and development activities and deliverables for employees in the Claims Department for Western Growers Assurance Trust (WGAT) and Pinnacle Claims Management, Inc. (PCMI). In addition to designing, developing, and facilitating learning, the Learning and Development Specialist Claims will evaluate learning program effectiveness by utilizing meaningful metrics. The Learning and Development Specialist Claims incorporates processes, policies, and systems in learning programs and is responsible for high quality delivery of all work assignments.

Qualifications

Bachelor’s degree or training certification and two (2) to three (3) years of experience designing learning (including e-learning) and facilitating training in a business environment preferred.
Healthcare experience preferred.
Experience in needs assessment, coordinating, planning, and evaluating learning programs.
Intermediate knowledge of medical claims processing for: Health Maintenance (HMO), Preferred Provider (PPO), and Exclusive Provider Organizations (EPO).
Experience with Flexible Spending Accounts (FSA), Consolidated Omnibus Budget Reconciliation Act plans (COBRA) Reinsurance (Stop Loss Carriers) plans, Medicaid, Medicare, State/Federal payers, and fully insured and self-insured benefit plans.
Familiarity with Healthcare laws and legislature including the Health Insurance Portability and Accountability Act (HIPAA), Multiple Employer Welfare Act (MEWA), and Employee Retirement Income Security Act (ERISA) regulations/compliance.
Exceptional skills in Microsoft Office suite: PowerPoint, Word, Outlook, Excel, and e-learning authoring software.
Exceptional understanding of adult learning theory and Instructional Systems Design (ISD).
Experience in working with learning technology solutions including learning management systems and online training platforms to help employees.
Experience with individualized coaching to facilitation direct practical skills training.
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

Instructional Design

Assess department learning needs by identifying knowledge and performance gaps in consultation with department managers, Subject Matter Experts (SMEs), and employees.
Design learning program materials for a variety of delivery mediums (including e-learning) utilizing effective design methodology.
Select from appropriate instructional methods; individual training, instructor led group facilitation, self- study, lectures, demonstrations, simulations exercises, role play and/or self-paced online training.
Evaluate and assess learning program effectiveness and develop means for improvement.
Assist with process identification, documentation, and process improvement initiatives.

Training Implementation

Facilitate learning and development content independently and/or in concert with SMEs.
Facilitate learning utilizing a wide variety of training methods to enable and reinforce learning.
Coordinate training sessions in a Learning Management System, schedule learners, and prepare learning materials.
Consult on techniques and skills for reinforcing learning with supervisors, SMEs, and managers.

Training Administration

Support learning programs to ensure functional learning objectives are met within cost and performance standards.
Identify learning program issues and support the development of creative solutions such as resources or modifying program specifications.
Schedule and coordinate the implementation of employee learning and development programs.

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, being self-accountable, creating a positive impact, and being 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.

#LI-REMOTE #LEARNINGANDDEVELOPMENT #CLAIMS #TRAINING

Learning and Development Specialist Claims

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