Jobs at Pinnacle Claims Management, Inc.

Processes and tracks medication prior authorizations, gathers clinical documentation, communicates with providers, payers, patients, and pharmacies, and coordinates denial appeals. Maintains accurate HIPAA-compliant records, audits authorization queues, monitors turnaround times, prepares reports and appeal workups, updates templates, supports audit readiness, and escalates clinical issues to pharmacists.

Owns the sales-to-implementation transition for new and upsold health plan business. Leads requirements discovery, validates scope and documentation, coordinates brokers, clients, Sales, Installation, and operational teams, identifies implementation risks, and ensures readiness for handoff. Maintains tracking tools and dashboards, monitors deadlines and outstanding requirements, improves workflows, supports revenue activation, and trains stakeholders on onboarding and documentation standards.

Manages employer benefits customer accounts for a third-party administrator, supporting implementation, administration, renewals, client and broker needs, and issue resolution. Advises on self-funded plans, pharmacy benefits, wellness, care management, and ancillary products. Analyzes claims and pharmacy data to identify cross-selling opportunities, collaborates with Sales on proposals, and maintains compliance with relevant healthcare regulations. Requires a California Life and Health insurance license and travel up to 30%.