Cleveland - 4 Workers%27 Compensation Claims Specialists - PN: 20068989, 20068990, 20069056, %2[...]

Ohio; Toledo (OH); On-site; USD 45,000 - 65,000; Full time

Job summary

A state agency seeks Claims Specialists to manage Workers' Compensation claims, coordinating with various stakeholders and processing claims. Applicants must demonstrate relevant experience in claims management, with training in business disciplines considered advantageous. Flex-time schedules available, fostering a supportive work culture.

Qualifications

• 36 months experience as claims representative or equivalent.
• Completion of a typing course; ability to type 35 words per minute.
• Understanding of workers' compensation laws and procedures.

Responsibilities

• Manages a caseload of Workers' Compensation claims.
• Processes various types of compensation requests.
• Conducts claims investigations and determination.

Skills

Claims Examination

Communication

Problem Solving

Education

Undergraduate core coursework in business or related field

Tools

Microsoft Office

Job description

Cleveland - 4 Workers%27 Compensation Claims Specialists - PN: 20068989, 20068990, 20069056, %26 20069074

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

What Our Employees Have to Say:
BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:

• 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 .

If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!

What You’ll Be Doing:

• Manages a caseload of Workers' Compensation claims: Coordinates and collaborates with internal and external stakeholders, Medical Service Specialists, Managed Car Organization, Employer Management team, Safety and Hygiene, injured workers, employers, Third Party Administrators, and rehabilitation personnel to set return to work expectations.
• Performs initial/subsequent claims investigation and determination within prescribed timeframes: Contacts parties involved in claim process; completes investigation during initial claim development to determine information pertinent to management of claim.
• Processes various types of compensation ranging from Temporary Total 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 and referrals to the Industrial Commission of Ohio.
• Responds to customer inquiries.
• Follows Ohio Revised Code and BWC policies and procedures.
• Communicates with legal representatives, employers, claimants, etc.

To Qualify, You Must Clearly Demonstrate:

36 months experience working in private insurance organization as claims representative or equivalent position AND successful completion of one typing course or demonstrate ability to type 35 words per minute.

-Or Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field AND successful completion of one typing course or demonstrate ability to type 35 words per minute.

-Or 24 months experience 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 months experience 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 months experience 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 months experience 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.

Job Skills: Claims Examination

Major Worker Characteristics:

Knowledge of: workers' compensation laws, policies & procedures*; eligibility criteria & procedures used for processing workers' compensation claims*; English grammar & 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 Commission processes*; claims reserving*;

Skill in: operation of a 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)*; operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., listening, writing, reading, phone etiquette); use of internet;

Ability to: define 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; work with a team; use International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.

Unusual Working Conditions:

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

THIS CLASSIFICATION MAY REQUIRE THE USE OF PROFICIENCY DEMONSTRATION TO DETERMINE MINIMUM QUALIFICATIONS

About the company

Ohio is a state in the Midwestern region of the United States. Of the fifty states, it is the 34th-largest by area, and with a population of nearly 11.8 million, is the seventh-most populous and tenth-most densely populated.

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