At Paramount Health Care, we offer insurance to both large and small groups and also cater to Medicare (Paramount Elite) subscribers in northwest Ohio and southeast Michigan. Our Medicaid product (Paramount Advantage) services those living in the state of Ohio. We maintain an accreditation by the NCQA – the National Committee for Quality Assurance – for our Ohio HMO, Elite and Advantage products. We’re also part of ProMedica, which is ranked the second most integrated health system in the U.S. and No. 1 in the Midwest. For more information about Paramount, please visit our website http://www.paramounthealthcare.com.
Responsible for consulting with new and existing clients & injured workers regarding the ProMedica Group of companies’ products and services. Actively participates in claims management and effectively returning employees to work. Works closely with the Director of Claims in both the SI and SF departments. Has authority to set reserves and negotiate settlements up to designated limits.
ACCOUNTABILITIES
1. Builds relationships with current or potential customers and injured workers to identify needs and/or resolve issues through consulting, claims adjusting, sales and customer service activities.
2. Answers client questions about products and prices, relevant to their unique situation. Clients can be internal staff or external employers to the system. Offers solutions based on best practices within industry standards.
3. Consults with clients to resolve problems and provides ongoing support. Monitors and reviews information from materials, events, or environment to detect or assess problems.
4. Performs administrative duties, such as preparing account reports, maintaining client files, sales records and data entry into management software.
5. Evaluates industrial injuries to determine compensability; Conducts a thorough investigation to ensure that all pertinent information is available prior to claim certification; Makes appropriate referral for disability management.
6. Reports claims and management’s position on compensability to appropriate state agency in a timely manner.
7. Interacts with internal or external management staff to gather all information regarding work related injuries, direct facility personnel on proper accident investigation.
8. Assesses claim to determine if surveillance, IMEs or settlements are necessary. Moves forward as appropriate with Director of Claims approval.
9. Performs any miscellaneous work assignments as may be required.
PREFERRED QUALIFICATIONS
Education: Bachelor’s degree in related field preferred
Skills: Superior understanding of Ohio and Michigan workers’ compensation programs for both self insurance and state fund. Proven account management capabilities in related professional services field required. Must possess excellent verbal and written communication skills, strong attention to detail, analytical thinking capabilities, and computer skills. Ability to successfully perform job duties in an independent, professional, organized, dependable, and ethical manner.
Years of Experience: 3-5 years of work-related skill, knowledge, or experience in similar environment required.
License: Adjuster license(s) preferred in states that require them.
Certification: Certifications such as Medical Assistant (MA), Licensed Practical Nurse (LPN), Medical Coding and similar programs will be considered.
ProMedica is a mission-based, not-for-profit integrated healthcare organization 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 [email protected]
Equal Opportunity Employer/Drug-Free Workplace
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