Claims Director - Paramount

OverviewThe Registered Nurse provides nursing care to individuals and groups which require specialized knowledge, judgment, and skill derived from the principles of biological, physical, behavioral, social, spiritual/cultural, and nursing sciences. The Registered Nurse functions within the full scope of nursing practice as noted by the Board of Nursing of their designated state for which they are practicing in addition to compliance with any of the hospitals accrediting bodies.Full-TimeLevel: MidTravel: NoSuccessProfileWho is the ideal Promedica employee? We''re looking for people to join our team who are motivated by making an impact and doing meaningful work. Responsible 10Compassionate 9Communicator 9Adaptable 9Multi-tasker 8Additional success profiles: Detail oriented, Flexible, Helpful, Patient, Responsible, Sincere, UnderstandingBenefitsProfessional GrowthRetirement & Savings PlanInnovative Training ProgramsTuition AssistanceCareer StabilityComprehensive Health CoverageJob RequirementsProMedica''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 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. SUMMARYThe Claims Director is responsible for oversight of all claim processes which include primary adjudication, adjustments, refunds and collections. Responsibility crosses multiple governmental and commercial product lines and various aspects of medical, vision and dental claims. Creation and revision of Medical Policies is also the responsibility of this position. This position will be responsible to produce quality outcomes and key performance metrics that meet and exceed all state and federal regulatory compliance, industry standard best practice and audit requirements for all areas of responsibility. The Director will also participate in the development of relationships with external stakeholders and internal departments to ensure timely, efficient and effective workflows. Colaborate with other leaders to execute on ProMedica wide initiatives. audit requirements. The Director of Claims will be expected to collaborate across multiple internal departments as well as with external stakeholders to implement and ensure timely, efficient and effective workflows within their departments. ACCOUNTABILITIES Current knowledge and compliance of all state and federal mandated regulations and contractual requirements to ensure applicable changes are identified and implemented timelyOversight of department operations within budget scopeMaintain accurate and up to date policies and procedures for all areas of responsibilityDevelop and maintain a strong team through recruiting, mentoring and trainingMaintain continuous improvement by focusing on employee engagement, provider relations, member experience, quality/performance standards and accountabilityDevelop and monitor key performance indicators to meet and exceed goals for all areas of responsibilityEscalation point for timely resolution of issues or compliant for all areas of responsibilityPerform other duties as assignedREQUIRED QUALIFICATIONSEducation: Bachelors Degree in Finance, Accounting, Healthcare Administration or other related area. Associate degree in related area with current coding credentials may be considered in lieu of Bachelors DegreeSkills: Strong verbal and written communication and organizational planning skills Demonstrated experience in creating and leading complex activities and processesAbility to lead teams and engage with all levels of an organization. Knowledge of medical billing, claims, medical terminology, claims forms, health insuranceProficient with Microsoft Office - emphasis on Excel and Power PointExperience with leading groups of individuals as well as one on one coachingKnowledge of federal mandated regulationsYears of Experience: : Minimum 10 years in a healthcare setting with demonstrated leadership progression. PREFERRED QUALIFICATIONSEducation: Master''s Degree in related fieldSkills: Knowledgeable in claims for a variety of specialties (acute, ambulatory, ASC, dialysis, transplants, etc), Knowledge of various state and federal mandated regulationsCertification: CPC, CCS, RHIT, RHIA or similar certificationADDITIONAL EXPERIENCEInternal candidates will be expected to demonstrate their ability to maintain current department workflows while meeting or exceeding current assigned key performance indicators.WORKING CONDITIONSPhysical Demands: Typical sitting, standing, typing, lifting associated with a basic office environment.ProMedica is a mission-based, not-for-profit integrated healthcare organizational headquartered in Toledo, Ohio. For more information, please visit 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 [Click Here to Email Your Resumé]Equal Opportunity Employer/Drug-Free Workplace

Created: 2026-03-07