Claims QA Auditor - Claims - Paramount
Company: ProMedica
Location: Toledo
Posted on: January 27, 2023
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Job Description:
ProMedica's health plan, Paramount Insurance, offers health
insurance products across six Midwest states. Paramount is an
Ohio-based health insurance company, headquartered in Toledo. The
organization has more than 800 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. http://www.paramounthealthcare.com. Basic
Purpose:
Perform quality assurance functions as they pertain to claims
transactions audits by means of identifying, documenting, and
communicating information. -The Claims QA Auditor maintains, and
provides statistical reports to claims management as requested.
-Works cooperatively with the claims trainer and claims team
leaders to propose and implement solutions to always provide the
best outcomes for our groups, members, and providers. -Supports
activities related to internal/external audits to ensure timely
dissemination of requested information/materials. -No positions
report directly to this position.
-Primary Duties:
-
General Information/Qualifications:
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 employment@promedica.org Equal Opportunity
Employer/Drug-Free Workplace
Keywords: ProMedica, Toledo , Claims QA Auditor - Claims - Paramount, Other , Toledo, Ohio
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