**Job Details**

**Team Leader, Underwriting and Claims - PPS TPA - Full Time - Days - (62710)**

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Job Title Team Leader, Underwriting and Claims - PPS TPA - Full Time - Days Category Business Professional Organizational Unit ProMedica -> Paramount -> Paramount Preferred Solutions -> Pps - Tpa (9360) Location Cleveland, OH 44114-1158 US (Primary)

Job Description 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. Were 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.

Under the direction of the PPS Risk Manager, this working team lead provides Risk and administrative support for Ohio Workers Compensation third-party administration of claims, including but not limited to Risk management programs directed to premium reduction programs, and related customer service functions.

**ACCOUNTABILITIES**

1. Prepares alternative options for manual classifications and prepares experience and premium impact reports.

2. Reviews, researches, and analyzes employer payroll audits performed by the BWC and files appeals when necessary.

3. Assists employer with preparation for a premium audit. Is knowledgeable in reportable remunerations, IRS tax guidelines, structuring of entities and corporations.

4. Researches, reviews, and analyzes employer lapse situations. Evaluates the employers experience to determine premium impact and legal implications. Researches and prepares analytical documents for non-coverage claim settlements.

5. Assists PPS Risk Manager, account executives, and brokers by maintaining and reporting data in SalesForce; coordinating E-blasts through SalesForce to all employer clients; and coordinating provision of safety training to employer clients.

6. For Self Insured employer clients: prepares weekly checks; monthly reports to clients; submits medical bills for repricing and prepares reports; prepares monthly Excess Carrier Reports; annually prepares 1099s for vendors and SI Reports for the BWC.

7. Coordinates and negotiates lump-sum settlements for relevant state-funded and self-insured claims.

8. Distributes correspondence promptly to the correct personnel. Answers and transfers phone calls.

9. Other duties as assigned.

Job Requirements REQUIRED QUALIFICATIONS

**Education:** Associates Degree in business or related field.

**Skills:** Excellent verbal communication skills and attention to detail. Demonstrated ability to utilize Microsoft Office Suite, Understanding of Ohio TPA services

PREFERRED QUALIFICATIONS

**Education:** Bachelors degree in business or related field.

**Skills:** Ohio workers compensation knowledge; medical terminology knowledge, experience using claims management software, and customer relationship management software

**Years of Experience:** Minimum two years of experience in insurance or risk management

*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*

Employee Exemption Type Exempt Job Type Full Time Budgeted Hours / Pay Period 80 Shift Type Days Shift Hours 8 hours Weekends N/A On-call Requirements Call Not Required Additional Schedule Details