Training Claims Specialist - Paramount
Company: ProMedica
Location: Elyria
Posted on: September 13, 2023
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Job Description:
Paramount Health Care, a ProMedica Health Plan, offers insurance
products across six Midwest states. This Ohio-based company,
headquartered in Toledo, has more than 685 employees dedicated to
serving their health plan members. -
Paramount offers Medicare Advantage and Marketplace Exchange health
plans for individuals and families. Paramount maintains
accreditation by the National Committee for Quality Assurance
(NCQA) for their HMO and Medicare Advantage products.
In addition, Paramount has a full complement of insurance products
for employers of any size, including medical, dental, vision and
workers' compensation, as well as vocational rehabilitation,
life-care planning and wellness.
As a part of ProMedica, Paramount is driven by ProMedica's mission
to improve your health and well-being. ProMedica has been
nationally recognized for its advocacy programs and efforts to
address social determinants of health. Paramount strives to provide
an exceptional experience to every member. For more information
about Paramount, please visit our website at
paramounthealthcare.com.
REPORTING RELATIONSHIPS/SUPERVISORY RESPONSIBILITIES
The employee is responsible for assisting the Non-Clinical Claims
Process Manager in developing and implementing training programs
for all staff in accordance with Ohio Bureau of Workers'
Compensation (OBWC) contractual and policy requirements. -
POSITION SUMMARY
This position reports directly to the Non-Clinical Claims Process
Manager. - The employee is part of the senior leadership team that
assists in setting performance metrics, evaluating productivity,
and helping workers create long-term career plans within an
organization. -
ACCOUNTABILITIES
*All duties listed below are essential unless noted otherwise*
Maintains a thorough understanding of the skills and competencies
associated with the entire Managed Care Organization's operations
including URAC standards and ProMedical Managements' Quality
Improvement program. -
This position can be filled in Cleveland, OH, Columbus, OH, Toledo,
OH or Wheeling, WV.REQUIRED QUALIFICATIONS
Education: A bachelor's degree in a health-related field or 3 years
of experience in Ohio Workers' Compensation (OBWC).
Skills: Expert knowledge of the following areas required: - OBWC
contract, URAC Accreditation, claims processing, medical
terminology, medical billing, and CPT and HCPC coding. Exceptional
written, telephonic, and oral communication (public speaking),
leadership, problem-solving, interpersonal, and organizational
skills are required. - Ability to coordinate and organize multiple
priorities.
Years of Experience: minimum of 3 years of experience in Ohio
Workers' Compensation (OBWC).
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WORKING CONDITIONS
Personal Protective Equipment: N/A
Physical Demands: N/A
Travel: This position requires approximately 25-35% of travel
between Columbus, Cleveland, Youngstown, Toledo, and Wheeling, WV
using a personal vehicle. Occasional overnight stays in these
locations may be required.
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ProMedica is a mission-based, not-for-profit integrated healthcare
organizational headquartered in Toledo, Ohio. - -For more
information, please visit -www.promedica.org/about-promedica
Qualified applicants will receive consideration for employment
-without regard to race, color, national origin, ancestry,
religion, -sex/gender (including pregnancy), -sexual orientation,
gender identity or gender expression, age, physical or mental
disability, military or protected veteran status, citizenship,
familial or marital status, genetics, or any other legally
protected category. In compliance with the Americans with
Disabilities Act Amendment Act (ADAAA), if you have a disability
and would like to request an accommodation in order to apply for a
job with ProMedica, please contact -employment@promedica.org
Equal Opportunity Employer/Drug-Free Workplace
Keywords: ProMedica, Elyria , Training Claims Specialist - Paramount, Other , Elyria, Ohio
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