(2) Cleveland- Claims Specialist (20068990, 20069001)

State of Ohio; Cleveland (OH); On-site; USD 37,000 - 48,000; Full time

Job summary

Ohio Bureau of Workers' Compensation in Cleveland, OH is seeking a Claims Examiner to manage a caseload of workers’ compensation claims and coordinate with internal and external stakeholders to set return-to-work expectations.

The role involves initial and subsequent claims investigations, determinations within timeframes, and processing various compensation types, with a standard 8:00 am–5:00 pm schedule in a full-time, on-site capacity.

Qualifications

• 36 mos. exp. in position requiring evaluation of medical or public assistance benefits (e.g., health insurance benefits, disability benefits, workers’ compensation benefits, unemployment benefits, public assistance benefits for food subsidies) in order to determine eligibility for benefits, approve or deny claims, resolve benefit-related disputes, calculate benefit payments, &/or perform similar benefit-related duties.

Responsibilities

• Manages a caseload of Workers’ Compensation claims: communicates, coordinates & collaborates with internal & external stakeholders to set return to work expectations.
• Performs initial/subsequent claims investigation & determination within prescribed timeframes.
• Process various types of compensation including TT, Wage Loss, Permanent Partial, Living Maintenance, Lump Sum Advancement; address subsequent requests.

Skills

Claims Examination

Job description

Organization: Workers' Compensation

Agency Contact Name and Information: Ohio Bureau of Workers' Compensation Human Resources, [e-mail]

Work Location: 615 Superior Ave. W., 6th Floor Cleveland, Ohio, 44113 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.

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:

• BWChas been a great place to work as it has provided opportunities for growththat were lacking in my previous place of work.
• I haveworked at several state agencies and BWC is the best place to work.
• Bestplace to work in the state and with a sense of family and support.
• I lovethe work culture, helpfulness, and acceptance I've been embraced with atBWC.
• Icontinue to be impressed with the career longevity of our employees, theirlevel of dedication to service, pride in their work, and vast experience.It really speaks to our mission and why people join BWC and then retirefrom 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 workstatus 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; address 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

• 36 mos. exp. in position requiring evaluation of medical or public assistance benefits (e.g., health insurance benefits, disability benefits, workers’ compensation benefits, unemployment benefits, public assistance benefits for food subsidies) in order to determine eligibility for benefits, approve or deny claims, resolve benefit-related disputes, calculate benefit payments, &/or perform similar benefit-related duties.

• Or completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; 12 mos. exp. in position requiring evaluation of medical or public assistance benefits (e.g., health insurance benefits, disability benefits, workers’ compensation benefits, unemployment benefits, public assistance benefits for food subsidies) in order to determine eligibility for benefits, approve or deny claims, resolve benefit-related disputes, calculate benefit payments &/or perform similar benefit-related duties.

• Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 &/or BWC Customer Service Representative, 64451, &/or BWC Employer Service Representative, 63521.

• Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721.

• Or any combination of at least 36 mos. exp. in position requiring evaluation of medical or public assistance benefits &/or as Workers' Compensation Claims Assistant, 16720, &/or as BWC Customer Service Representative, 64451 &/or as BWC Employer Service Representative, 63521.

• Or equivalent of Minimum Class Qualifications For Employment noted above.

Job Skills: Claims Examination

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.