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Medical Operations Specialist

Denver

Pinnacol Assurance does just one thing, and does it better than anyone: provide caring workers’ compensation protection to Colorado employers and employees. And while we may be a little biased, we believe that our work shapes communities and changes lives.

We have big hearts and love big ideas. We’ve been around for more than  100 years, but don’t let that fool you. Pinnacol is committed to taking care of Colorado employers and workers in the most innovative ways. We celebrate continuous improvement, new ideas, compassion, teamwork, integrity and excellence.

What you’ll do:

Serve as organizational medical payments subject matter expert, analyzing data to ensure quality, integrity and consistency of medical payment processing and quality assurance and audit operations.

What you can expect:

  • Assists, completes or works on special projects as assigned. Performs research, analytics and follow-up as required.
  • Serves on various committees, as assigned.
  • Serve as resource to Company’s leadership team and broader organization
  • Coordinate work by directing team members based on need and priorities.
  • Champion the training and professional development of Medical Payments and Quality team members by leveraging clearly defined expectations, driving standard work practices, and maintaining current procedure manuals.
  • Monitor individual performance, provide coaching and timely performance feedback
  • Establish action plans to address, resolve, and improve identified training opportunities supporting company claims management and resolution goals
  • Collaborate with experts and/or leaders to create best in class lean practices, including standard work and efficient work processes.
  • Collaborate with other disciplines to develop MOHS strategies/plans.
  • Interpret and explain complex information regarding workers’ compensation payment management, and regulatory and legislative issues to ensure compliance and consistency
  • Maintain a big picture understanding of payment management with a strategic understating of overall business operations
  • Escalate procedural and process issues and inconsistencies to management

 

ADDITIONAL DUTIES:
  • Attend educational classes to ensure understanding of current law, regulatory requirements, and workers’ compensation system trends
  • Develop and maintain appropriate relationships with individuals within CO Division of Workers’ Compensation and other external agencies and stakeholders
  • Third party vendor Liaison and Administrator
  • Perform other duties as assigned

What you need to be successful:

  • Bachelor’s Degree strongly preferred. Relevant work experience (similar kind of work at a similar level of work as described in the essential duties) may be substituted for the bachelor's degree.
  • Completion of a degree is encouraged and supported.
  • Knowledge of the Colorado workers’ compensation system is needed.
  • Experience in workers’ compensation is preferred.
  • Strong problem solving and communication skills are required. 

WORK ENVIRONMENT / PHYSICAL ACTIVITIES:

  • Regular attendance required. Extensive telephone and computer work in an office environment. There will be on call times. 

DISCLAIMER:

  • This description is not an exhaustive list of all duties, responsibilities or qualifications associated with this job.

We can’t do our work without people like you.
Our employees are extraordinary and committed to making a difference. Here’s some of the ways we show our appreciation.

  • Our benefits go beyond the basics. You’ll get to choose from diverse benefit offerings for medical, dental and vision.
  • We care about each other. We enjoy a positive, collaborative work environment. We are hard workers and high performers.
  • We love who you are. Pinnacol is on a journey to embody diversity, equity and inclusion. We’re committed to creating a culture that deeply values differences, where everyone feels like they belong.
  • Take a day (or 20!) off. Enjoy 20 paid days off your first full year plus 9 paid holidays.
  • Take care of yourself. Sign up for unique wellness programs, including on-site, company-paid fitness facilities and classes
  • Get your learning on. We promote a learning culture to help you master your current job and cultivate the skills of the future through a variety of on-site, online, and off-site professional development opportunities.
  • Give back and get paid. Through our employee volunteer program, Pinnacol in Action, employees receive paid time off to volunteer with Colorado nonprofits.
  • Share in our success. You’ll have the opportunity to earn a quarterly incentive, up to 12 percent of your annual base salary, when your team exceeds their goals and objectives.

When we find the right person, we try to put our best foot forward with an offer that excites you. We consider what you’d like to be paid, the skills and experience you bring, what similar jobs pay in the Denver area and make sure there’s equal pay for equal work among those you’ll be working with. The compensation amount for this role is targeted at $94000-$103300. Final offer amounts are determined by multiple factors including your experience and expertise and may vary from the amounts listed above.

Want to love your work? Apply today!

Pinnacol is committed to working with and providing reasonable accommodations to applicants with disabilities. To request assistance with the application process, please email recruiting_team@pinnacol.com.

This posting will close 5 days after being published: 6/2/2025

 

Salary Range

$94,000 - $103,300 USD

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