Bilingual Operations Specialist II

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: $46,669.19 – $60,668.60 with a rich benefits package that includes profit‑sharing.

This position reports to the Supervisor I, Key Accounts. It is responsible for serving as the first point of contact for Operations Specialists I and Field Operations Specialists assigned to their Pod, processing financial transactions in the company’s financial processing systems related to individual and group billing, ACH, and cash receipt processing. The incumbent will also maintain and balance individual accounts receivable including delinquency processing and terminations, manage all financial aspects of reimbursement requests submitted by consumers, generate desired reports, and process and approve reimbursement payments.

The incumbent is responsible for managing all incoming claims and reimbursement requests and processing claims and client reimbursements, including complex claim cases requiring research and resolution. Additionally, the role mentors and supports the development of Specialists level I in conjunction with the Team Lead.

• BA/BS degree in accounting, finance or business‑related field preferred; 3–4 years of related experience or equivalent combination of education and experience.
• Excellent oral and written communication skills in English and Spanish, including modern business communications, formatting of professional letters, reports and phone etiquette.
• Comprehensive command of Spanish language with the ability to utilize up to 50% of the time.
• Demonstrated ability to multi‑task, work in a fast‑paced environment, meet established deadlines, and work independently with minimal supervision or in a team environment.
• Proficient knowledge of end‑user office software (calendaring, word‑processing, spreadsheet and email) and the ability to develop strong proficiency working with a proprietary Health Care system.
• Advanced customer service skills.
• Moderate ability to analyze and resolve technical problems and/or client inquiries as they arise.
• Intermediate knowledge of generally accepted Health Care Eligibility and Billing procedures and of HIPAA, COBRA, Cal‑COBRA, MEWA and ERISA regulations.
• Knowledge of health insurance industry and standard healthcare eligibility provisions.
• 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).
• Designated room for your office or steps taken to protect company information (e.g., facing computer toward wall, etc.).
• A functioning smoke detector, fire extinguisher, and first aid kit on site.

• Maintain/manage all Key Account contribution/premium reimbursements, COBRA payments and enrollments, and vendor pass‑through payments for Key Accounts.
• Manage complex account reconciliations, special assignments, and build ad‑hoc reports.
• Verify and…