Training Specialist - Claims
Company: ProMedica Senior Care
Location: Toledo
Posted on: January 27, 2023
Job Description:
At Paramount, 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. Position SummaryThe Training
Specialist is responsible for development and implementation of
training programs for Provider Experience staff. Support corporate
objectives by working with management to provide an effective
education program that will advance the quality and production
level of the interdepartmental staff. Develop comprehensive
documentation for all types of customer service including incoming
call centers, credentialing, provider database management, provider
relations and claims processing, for all lines of business
including specialty and governmental. Department liaison for all
systems upgrades. ACCOUNTABILITIES
- Responsible to provide training for new and/or current Provide
Experience Department staff..Provide quality assurance for trainees
through their training period.Assist with the orientation and
integration of new to Paramount employees into the Provider
Experience departments.Work directly with department staff and
leadership to review issues and develop a corrective action plans,
as needed, based on QA results.During training period, compile and
analyze production data reports based on key performance
indicators, and provide summary to team leaders, as well as
recommendations for improvement in deficient areas.Participate
extensively in the implementation of new software/programs that
affect the rProvider Experience Departments, to support testing and
recommendation of such applications.Perform other duties as
directed to support Provider Experience.Actively participates in
shared accountability and commitment for departmental and
organization-wide results. Support departmental/team goals and
objectives.
- Education: Associates degree or equivalent experience in
education, teaching, training, or claims processing
proceduresSkills: Ability to handle difficult situations, desire to
help others grow and develop.Years of Experience: 1-3
yearsPreferred Qualifications
- Education:. Bachelor's Degree in Education, Marketing,
healthcare or equivalent experience with training.Skills:
Presentation skills, facilitation skills, Understand the Adult
Learning Principles. Detailed knowledge of all aspects of medical
and facility claims processing. Functional knowledge of adult
learning theory, assessment, and evaluation is a plus.Years of
Experience: Three to five years of processing all types of claims
and/or customer service. Minimum of three years' experience in
health insurance industry. Experience with multiple online software
systems.License: TeachingCertification: Teaching ADDITIONAL
EXPERIENCEAbility to interpret data, explain process of the "what,
how, and why" of a claim.Documented knowledge with Word, Excel, and
Access required. Demonstrated excellent written and oral
communication skills.Must have excellent interpersonal skills, and
must present a professional image for interaction with a variety of
contacts.Must be adaptable to change and must be
detail-oriented.Have ability to take initiative, work
independently, and make sound judgment decisions.Demonstrated
ability to handle details and maintain confidential
information.Must be able to prioritize and handle large volumes of
work.Must have ability to work in a production environment that can
be stressful.Must maintain a high level of motivation, initiative,
and accountability.Must be able to handle conflict in a positive,
productive manner.Have ability to work in an open concept office
environment. ProMedica is a mission-based, not-for-profit
integrated healthcare organizational headquartered in Toledo, Ohio.
For more information, please visit
www.promedica.org/about-promedicaQualified 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.orgEqual Opportunity Employer/Drug-Free
Workplace
Keywords: ProMedica Senior Care, Toledo , Training Specialist - Claims, Other , Toledo, Ohio
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