Training Claims Specialist - Paramount

Company: ProMedica
Location: Elyria
Posted on: September 13, 2023

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. -
  
• Provides support and ongoing training to the ProMedica Medical Management non-clinical staff. - This includes participating in the new employee orientation training and onboarding in each of ProMedica Medical Managements' regional offices when needed.
  
• Creates training programs for new and existing staff with oversight from the Non-Clinical Process Manager.
  
• Works with management staff to determine additional or refresher training for team members.
  
• Designs, prepares, and produces all necessary documents and presentations for training modules.
  
• Assists in the coordination of company quality improvement projects and programs as well as maintains active participation in all meetings. -
  
• Performs performance evaluations and audits as needed.
  
• Participate in educational and informational seminars as needed.
  
• Other duties may be assigned.
  
  
  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