Strategic Workers' Comp Claims Examiner

State of Ohio; Columbus (OH); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Medical Coverage

11 paid holidays per year

Paid time off

Job summary

State of Ohio’s Workers' Compensation division in Columbus seeks a WC Claims Specialist to manage a workload of workers’ compensation claims, coordinate with DMC, MSS, MCO, and other stakeholders, and determine claim details within required timeframes.

You will perform investigations, process various compensation types, respond to inquiries, and follow Ohio Revised Code and BWC procedures. Strong analytical and communication skills are essential.

Qualifications

• 36 mos. exp. in position requiring evaluation of medical or public assistance benefits to determine eligibility for benefits, approve/deny claims, or related duties.
• 12 mos. exp. in an undergraduate core field (business, humanities, social/behavioral science, education) to determine eligibility for benefits or related duties.
• 24 mos. exp. as Workers' Compensation Claims Assistant, 16720, or BWC Customer Service Rep, 64451, or BWC Employer Service Rep, 63521.
• 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 or equivalent mix of relevant duties.

Responsibilities

• Manages a caseload of Workers’ Compensation claims and coordinates with internal/external stakeholders to set return-to-work expectations.
• Performs initial/subsequent claims investigations and determinations within timeframes.
• Processes various compensation types (TT, Wage Loss, PPD, Living Maintenance, Lump Sum) and handles related requests.
• Responds to customer inquiries and adheres to Ohio law and BWC policies.
• Communicates with legal representatives, employers, claimants, and other parties.

Skills

Claims Examination

Customer Service

Attention to Detail

Critical Thinking

Teamwork

Time Management

Written Communication

Tools

Workers’ Compensation Claims Management System

Intrafin

FMS fraud system

Microsoft Office

Job description

State of Ohio’s Workers' Compensation division in Columbus seeks a WC Claims Specialist to manage a workload of workers’ compensation claims, coordinate with DMC, MSS, MCO, and other stakeholders, and determine claim details within required timeframes.

You will perform investigations, process various compensation types, respond to inquiries, and follow Ohio Revised Code and BWC procedures. Strong analytical and communication skills are essential.