Workers' Comp Claims Examiner

Taleo; Cambridge (OH); On-site; USD 55,000 - 72,000; Full time

Job summary

Ohio Bureau of Workers' Compensation is seeking a CambridgeWC Claims Specialist 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 claim investigations, processing multiple compensation types, responding to inquiries, and ensuring adherence to state laws and BWC policies. The position is on-site with standard full-time hours and OCSEA union support.

Qualifications

• 36 mos. exp. in position requiring evaluation of medical or public assistance benefits to determine eligibility for benefits, approve/deny claims, resolve disputes, or similar duties.
• Undergrad coursework in business, humanities, social/science, education or related field; 12 mos. exp. in similar duties.
• Or 24 mos. exp. as Workers' Compensation Claims Assistant / BWC Customer Service Representative / Employer Service Representative.
• Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist.
• Any combination totaling at least 36 mos. exp. in related duties or equivalent minimum qualifications.

Responsibilities

• Manages a caseload of Workers’ Compensation claims and coordinates with internal/external stakeholders to set return-to-work expectations.
• Performs initial/subsequent claim investigations & determinations within prescribed timeframes and gathers information on jurisdiction, coverage, causality, and job demands.
• Processes compensation types (TT, Wage Loss, PPI, Living Maintenance, Lump Sum) and handles related follow-up via due process and referrals.
• Responds to customer inquiries.
• Follows Ohio Revised Code and BWC policies and procedures.
• Communicates with legal representatives, employers, claimants, etc.

Skills

Claims Examination

Customer Service

Attention to Detail

Critical Thinking

Teamwork

Time Management

Written Communication

Job description

Ohio Bureau of Workers' Compensation is seeking a CambridgeWC Claims Specialist 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 claim investigations, processing multiple compensation types, responding to inquiries, and ensuring adherence to state laws and BWC policies. The position is on-site with standard full-time hours and OCSEA union support.