Workers' Comp Claims Examiner

State of Ohio; Columbus (OH); On-site; USD 76,158,000 - 98,810,000; Full time

Benefits offered by this job

OCSEA union

Job summary

State of Ohio, Columbus-based, is seeking a WC Claims Specialist to manage a caseload of workers’ compensation claims and coordinate with internal and external partners to set return-to-work plans.

The role requires extensive claims examination experience, strong customer service, and knowledge of relevant laws. On-site work at the William Green Building with a 40-hour schedule and OCSEA union participation.

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.

Responsibilities

• Manages a caseload of Workers’ Compensation claims: coordinates with internal & external stakeholders to set return to work expectations.
• Performs initial/subsequent claims investigation & determination within prescribed timeframes; gathers information to determine jurisdiction, coverage, causality, and current work status.
• Processes compensation types including Temporary Total, Wage Loss, Permanent Partial, and Lump Sum advancements; handles referrals to IC Ohio as needed.
• Responds to customer inquiries and follows Ohio Revised Code and BWC policies and procedures.
• Communicates with legal representatives, employers, claimants, etc.

Skills

Claims Examination

Customer Service

Job description

State of Ohio, Columbus-based, is seeking a WC Claims Specialist to manage a caseload of workers’ compensation claims and coordinate with internal and external partners to set return-to-work plans.

The role requires extensive claims examination experience, strong customer service, and knowledge of relevant laws. On-site work at the William Green Building with a 40-hour schedule and OCSEA union participation.