(2) Canton- Claims Specialists (20068366, 20069887)

State of Ohio; North Canton (OH); Presencial; USD 37 000 - 48 000; Tempo integral

Resumo da oferta

The Ohio Bureau of Workers' Compensation is seeking a Claims Examiner to manage a caseload of workers’ compensation claims. You will coordinate with internal and external stakeholders to set return-to-work expectations and gather information essential for claims management.

Responsibilities include initial and ongoing investigations, processing multiple compensation types, and ensuring compliance with the Ohio Revised Code and BWC policies.

Qualificações

• Undergraduate core coursework in business, humanities, social & behavioral science, education or related field.
• 36 months of experience in private insurance organization as claims representative or equivalent.
• 24 months of experience as Workers' Compensation Claims Assistant or related role.
• 24 months as BWC Customer Service Representative or Employer Service Representative roles.
• 12 months as Workers' Compensation Medical Claims Specialist.

Responsabilidades

• Manages a caseload of Workers’ Compensation claims, coordinating with Disability Management Coordinators, Medical Service Specialists, MCOs, employers and other stakeholders to set return-to-work expectations.
• Performs initial/subsequent claims investigation and determination within prescribed timeframes, gathering information on jurisdiction, coverage, causality and current work status.
• Processes various compensation types (TT, Wage Loss, Permanent Partial, Living Maintenance, Lump Sum) and handles follow-up requests per due process and referrals.
• Evaluates information to issue orders and decisions in line with Workers' Compensation law and policy development, collaboration with MCOs.
• Responds to customer inquiries and maintains compliance with Ohio Revised Code and BWC procedures.
• Communicates with legal representatives, employers, claimants, and other parties as required.

Conhecimentos

Claims Examination

Descrição da oferta de emprego

All job postings will expire at 11:59 PM Eastern Time on the application deadline.

Organization

Bur of Workers' Compensation

Work Location

339 East Maple Street, Suite 200
North Canton, Ohio, 44720-2593
United States

Compensation

$26.54- $34.53

Schedule

Permanent - Full Time

Work Hours

8:00 am- 5:00 pm

Classified Indicator

Classified

Union

OCSEA

Primary Job Skill

Claims Examination

Who We Are

A Little About Us

With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers.

For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.

Our Culture

BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.

Our Vision

To transform BWC into an agile organization driven by customer success.

Our Mission

To deliver consistently excellent experiences for each BWC customer every day.

Our Core Values

One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.

What Our Employees Have to Say

• BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.
• I have worked at several state agencies and BWC is the best place to work.
• Best place to work in the state and with a sense of family and support.
• I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.
• I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.

BWC’s core hours of operation are Monday-Friday from8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at oneof BWC’s seven offices across the state. BWC offers flex-time workschedules that allow an employee to start the day as early as 7:00am or as lateas 8:30am. Flex-time schedules are based on operational need and requiresupervisor approval.

What You'll Do

• Manages a caseload of Workers’ Compensation claims: Communicates, coordinates & collaborates with internal & external stakeholders (e.g. Disability Management Coordinator [DMC], Medical Service Specialist [MSS], Managed Care Organization [MCO], Employer Management [EM] team, Safety & Hygiene, injured workers, employers, Third Party Administrators [TPA] & rehabilitation personnel) in order to set return to work expectations.
• Performs initial/subsequent claims investigation & determination within prescribed timeframes: Contacts parties involved in claim process; completes investigation during initial claim development to determine information pertinent to management of claim (e.g., jurisdiction, coverage, causality, compensability, claim data accuracy, current work status of claimant, job description, salary continuation, physical demands of job, & work history of claimant).
• Process various types of compensation ranging from Temporary Total (TT) Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests; addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders & referrals to the Industrial Commission (IC) of Ohio.
• Evaluates information & issues orders, makes claim allowance decisions in regard to Workers' Compensation law &/or policy develops, implements, customer care plan on all eligible claims through collaboration with MCOs (e.g. Return to Work); processes various types of compensation.
• Responds to customer inquiries
• Follows Ohio Revised Code and BWC policies and procedures
• Communicates with legal representatives, employers, claimants, etc.

Additional Information

EEO & ADA Statement

The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order. The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox [e-mail].

BWC OCSEA Selection Rights

This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.

Salary Information

Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.

Transportation

Position may require travel; therefore, persons occupying this position must be able to provide own transportation &/or legally operate a state-owned vehicle.

Educational Transcripts

For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.

All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.

Background Check

Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.

Why Work for the State of Ohio

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:

• Medical Coverage
• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
• Public Retirement Systems such as OPERS, STRS, SERS, and HPRS & Optional Deferred Compensation Ohio Deferred Compensation

*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

Qualifications

• Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute.
• Or 36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute.
• Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self- insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information, & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law).
• Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations) &/or as BWC Employer Service Representative, 63521, (i.e., providing information & assistance &/or responding to complaints, questions & inquiries from customers regarding workers’ compensation coverage, established binder/applications maintenance, demographics, supplemental & legal entities, manual classifications, debits/credits & payroll reports &/or various BWC programs & research & explain employer refunds, attorney general balances, payments made to policies &/or divided credits).
• or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers' Compensation).
• or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &/or as Workers' Compensation Claims Assistant, 16720 &/or as Workers' Customer Service Representative, 64451 &/or as Workers’ Compensation Employer Service Representative, 63521.
• Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment.

Major Worker Characteristics

Knowledge ofworkers' compensation laws, policies & procedures*; eligibility criteria& procedures used for processing workers' compensation claims*; Englishgrammar & spelling; oral & written business communication; public relations*;addition, subtraction, multiplication, division, fractions, decimals &percentages; interviewing techniques; internet search engines & navigation;medical terminology; medical diagnosis coding*; Industrial Commissionprocesses*; claims reserving*; Skill inoperation ofa personal computer; typing; use of Microsoft Office software (e.g., Outlook,Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., Workers’Compensation Claims Management System, Intrafin, FMS fraud system)*; operationof office machinery (e.g., calculator, printer, copier, fax, phone); communication skills (e.g., listening, writing, reading, phone etiquette); useof internet; Ability todefine problems, collect data, establish facts,& draw valid conclusions; read & understand medical reference manuals& reports, gather, collate, & classify information about data, people,or things; respond to sensitive inquiries from & contacts with injured workers,employers, providers or their representatives, & the public; answer routine& technical inquiries from injured workers, employers, medical providers& public*; make proper referrals (within agency & external sources)*; diffuse potentially volatile situations; present information to others; workwith a team; use International Classification of Diseases (ICD) codingmanuals/system*; generate properly formatted business correspondence; read andunderstand compensation payment plan screens*, interpret Cognos reports*.

(*) Developed after employment

ADA Statement

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

Drug-Free Workplace

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.