SALES REPRESENTATIVE - TPA at Aultman Health Foundation – CANTON, Ohio

PURPOSE OF POSITION:

The Account Representative has four major areas of responsibility, which are listed below:

1. Attend all of AultComp’s hearings before the Industrial Commission of Ohio, unless the presence of an attorney is required.
2. Manage the claims of designated self-insured employers.
3. Manage the claims of all state fund employers.
4. Market the services of the TPA, including the group rating program.

In performing the above tasks, the Account Representative will assist the Claims Coordinator, Clinical Editor, and the Customer with litigation issues, medical bill issues, and claims management issues. The Account Representative will request medical documentation from providers in order to prepare for hearings, schedule independent medical exams, and negotiate lump sum settlements. The Account Representative will also file motions, appeals, objections, lump sum settlement applications, and any other relevant correspondence with the Bureau of Workers’ Compensation and the Industrial Commission of Ohio, act as a liaison between the Customer and the Manager, and generate administrative billing. A more detailed description of the position is listed below.

RESPONSIBILITIES & EXPECTATIONS:

• Prepare docket based upon district, time, issue, and level of hearing.
• Attend all hearings in the Akron and Cambridge district offices unless an attorney is requested or there is a time conflict.
• Review and prepare all hearing files and distribute to subcontractors when appropriate.
• Advise Claims Coordinators regarding the information needed for hearings.
• Advise Clinical Editor regarding contested claims so bills are not paid in error.
• File appeals, objections, reconsiderations, motions, lump sum settlement applications, and any other correspondence with the Bureau of Workers’ Compensation and Industrial Commission of Ohio.
• Initiate settlement correspondence for self-insured and state fund clients.
• Request medical documentation for hearings from attending physicians and any other provider who administered treatment.
• Act as account representative for self-insured and state fund employers, advising clients regarding allowance or denial of claims, return to restricted duty, lump sum settlements, extent of disability, allowance or denial of additional conditions, treatment issues, independent medical exams, permanent partial disability objections, and hearing strategies.
• Market TPA services to self-insured, state funded, and group rated clients.
• Coordinate mailing of group rating material.
• Maintain group rating database.
• Prepare and mail group rating proposals
• Coordinate all correspondence with group administrators.
• Generate administrative billing, process payments, and maintain billing database.
• Authorize and submit subcontractor’s fees to finance for payment.

• Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
• Seeks supervisory guidance/approval as appropriate.
• Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
• Promotes and demonstrates professional standards to enhance the development of the department.
• Practices ethical conduct.
• Meets acceptable attendance and punctuality expectations (excluding FMLA)
• Reviews the files of self-insured clients to ensure that they are meeting BWC audit requirements.
• Reviews policies maintained on the Policy and Procedures website that pertain to the position.

The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and are not considered a detailed description of all the work requirements that may be inherent to this position.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.

QUALIFICATIONS:

• Education: Bachelor’s Degree required.
• Experience: Knowledge of medical terminology,
• Mastery of Microsoft Word, Excel and Outlook.
• Proficient with basic math skills.
• Prior employment with a workers’ compensation third party administrator or the Ohio Bureau of Workers’ Compensation required.

WORKING CONDITIONS:

• Hours of operation, shifts as assigned. Occasional overtime, on-call, off-shifts (evenings and/or weekends) scheduled as necessary.
• Lunch and break periods must be coordinated with other staff members to maintain adequate office staffing during departmental operating hours.
• Sitting/standing/moving about intermittently during working hours.
• Subject to frequent interruptions and changes in priority of duties throughout the day.