Senior Workers’ Compensation Claims Examiner

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

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Claims Examination

Job description

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.