Join our team of dedicated professionals who are committed to ensuring our clients can provide affordable health benefit solutions for their employees.

Part of the Western Growers Family of Companies (WGFC), Pinnacle Claims Management is a 3rd party administrator that provides health benefits administration and related services to companies that self-fund their insurance. We are also a contracted partner with CCSB.

Pinnacle is independently owned and has been serving clients for 20+ years. We are also part of the Western Growers Family of Companies.

For more details on open positions, visit our careers page!

Compensation:$31,569- $46,040 with a rich benefits package that includes profit-sharing.

Job Description Summary

Position reports directly to the Supervisor, Covered California for Small Business Call Center (CCSB). This position provides consultative telephonic and web-based assistance to Agents, Certified Enrollment Counselors, Qualified Health Plans (QHP), federal and state agencies and other stakeholders in Health Benefit Exchange administration. The incumbent will provide customer service support to clients by instructing them on correct eligibility management procedures and troubleshoot application issues and concerns.

Qualifications

• High School diploma or GED and one (1) to three (3) years of experience in customer service within a call center environment, preferably within a technical support role.
• Experience in the healthcare industry especially with a health benefits company or a federal, state benefit program a plus.
• Knowledge of Health Benefits Exchange (HBEX), eligibility requirements and the application and enrollment processes preferred.
• Strong written and verbal communication skills. including a very clear and concise speaking voice, and active listening.
• Demonstrated skills in time management and team building.
• Strong ability to research and resolve technical issues and/or client problems as they arise with minimal direction.
• Knowledge of government regulations, federal, state, and local health benefit programs preferred.
• Ability to retain and apply knowledge of the various operations of the organization, products, and services, in order to provide excellent customer service support.
• Ability to learn new software and navigate multiple systems at once. Must have strong knowledge of Customer Relationship Management (CRM) software.
• Ability to adapt to a constantly changing environment.
• Basic computer experience and keyboarding skills.
• Bilingual in Spanish, Chinese, Korean, and Vietnamese is a plus.

Duties And Responsibilities

Customer Advocate

• Foster and build working relationships with Agents, Certified Enrollment Counselors, federal and state agency contacts.
• Must become the subject matter expert for Covered California, State Provided Programs and HealthCare.Gov.
• Serve as a representative of the Agent by displaying professionalism, knowledge, and discretion in all interactions with other members of the Agent’s community and their customers.
• Adhere to the call center Quality Guidelines to ensure the best phone support to our callers.

Call Center Support

• Be a key contributor to meeting our contractual obligations to Covered California.
• Meet and maintain all of the department service metrics and performance objectives.
• Thoroughly document information, activities and changes in the database and inquiry outcomes for accurate tracking and analysis.
• Provide telephonic and web-based outreach to provide informational support to assist with all aspects of the application process within the Covered California systems from sign up to termination.
• Identify, initiate, and implement at least one process improvement and/or innovation annually.

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.
• 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 perform this job’s essential functions successfully. 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.