Job Details Claims Examiner - HMS - Full Time - Days - (36754) Job Title Claims Examiner - HMS - Full Time - Days Category Office / Administrative / Clerical Organizational Unit ProMedica -> Paramount -> Health Management Solutions -> HMS-Toledo (9000) Location Cleveland, OH 44128-5626 US Maumee, OH 43537 US (Primary) Job Description Thank you for inquiring about a position with Paramount. We are a NCQA accredited managed care plan, which is part of ProMedicas integrated healthcare system with offices in Maumee, Columbus, Cleveland, and Cincinnati. Paramount provides health insurance coverage for Medicare, Medicaid, and Commercial members. For more information about Paramount, please visit our website http://www.paramounthealthcare.com . Our mission is to improve your health and well-being. So were committed to your wellness with various initiatives, such as preventive services, online knowledge, health risk assessments, our Steps2Health disease management programs, health fairs, and more. Position Summary Paramount HMS Team is recruiting for a Claims Examiner. The Claims Examiner is the non-case management staff responsible for supporting the case management process. They always work under direct supervision of a Nurse Case Manager and does not make clinical judgment. They manage the communication and collaboration with injured workers (IW), employers, providers, third party administrators (TPA), attorneys, and the Ohio Bureau of Workers Compensation (BWC) to obtain a safe return to work (RTW) while working within BWC designated guidelines. The claims examiner processes all treatment requests (C-9s) within 72 hours to provide the IW with the treatment medically necessary and appropriate for the allowed conditions. They also effectively apply the MCO process including completion of appropriate medical management template, documentation of community resources, support systems, and psychosocial factors that may represent potential barriers to a successful RTW. HMS is an Ohio MCO certified to medically manage workers' compensation claims in Ohio. Our goal is to return injured employees to work quickly and safely. HMS is a provider owned MCO with access to the resources of an integrated healthcare system. Employers have a single point of contact and access to a team of professionals led by an experienced nurse case manager. Communication and collaboration with injured workers (IW), employers, providers, third party administrators (TPA), attorneys, and the Ohio Bureau of Workers Compensation (BWC) to obtain a safe return to work (RTW) while working within BWC designated guidelines. Adherence to all Health Management Solutions (HMS) policies and URAC standards Adherence to all Confidentiality policies and guidelines Process all Treatment Requests (C-9s) within 72 hours to provide the IW with the treatment medically necessary and appropriate for the Allowed Conditions. Staff C-9 requests with the Nurse Case Manager, or Medical Director as needed. Effectively apply the MCO process including completion of appropriate medical management template, documentation of community resources, support systems, and psychosocial factors that may represent potential barriers to a successful RTW. Job Requirements Minimum of 2 years managed care experience. Excellent knowledge of medical terminology Exceptional written, telephonic, and oral communication (public speaking), leadership, problem-solving, interpersonal, and organizational skills required. Ability to coordinate and organize multiple priorities. Experience using Microsoft Office programs, especially Excel, Word, PowerPoint, and Access. High School/GED Certificate Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics. Equal Opportunity Employer/Drug-Free Workplace Employee Exemption Type Non-Exempt Job Type Full-time Budgeted Hours / Pay Period 80 Shift Type Days Shift Hours Weekends On-call Requirements Additional Schedule Details Paramount HMS has 4 locations: Maumee, Ohio Warrensville Heights, Ohio Columbus, Ohio Wheeling, WV This position is available to work out of either the Toledo or Warrensville Heights offices. We can hire a permanent employee into either of these locations for this position.