Columbus- Special Claims Specialist - PN : 20068710

Ohio JobsColumbus, OH, US

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Columbus- Special Claims Specialist

Organization : Workers' Compensation

Compensation : $25.77 - $33.52

Schedule : Full-time

Work Hours : 40

Union : OCSEA

Primary Job Skill : Claims Examination

Technical Skills : Claims Examination, Customer Service

Professional Skills : Attention to Detail, Critical Thinking, Teamwork, Time Management, Written Communication

A Little About Us : With roughly 1,500 employees in seven offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.

Our Culture : BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.

Our Vision : To transform BWC into an agile organization driven by customer success.

Our Mission : To deliver consistently excellent experiences for each BWC customer every day.

Our Core Values : One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.

What You'll Be Doing :

Manages a caseload of Workers' Compensation claims : Communicates, coordinates & collaborates with internal & external stakeholders (e.g. Disability Management Coordinator [DMC], Medical Service Specialist [MSS], Managed Care Organization [MCO], Employer Management [EM] team, Safety & Hygiene, injured workers, employers, Third Party Administrators [TPA] & rehabilitation personnel) in order to set return to work expectations.
Performs initial / subsequent claims investigation & determination within prescribed timeframes : Contacts parties involved in claim process; completes investigation during initial claim development to determine information pertinent to management of claim (e.g., jurisdiction, coverage, causality, compensability, claim data accuracy, current work status of claimant, job description, salary continuation, physical demands of job, & work history of claimant).
Process various types of compensation ranging from Temporary Total (TT) 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 & referrals to the Industrial Commission (IC) of Ohio.
Evaluates information & issues orders, makes claim allowance decisions in regard to Workers' Compensation law & / or policy develops, implements, customer care plan on all eligible claims through collaboration with MCOs (e.g. Return to Work), processes various types of compensation.
Responds to customer inquiries
Follows Ohio Revised Code and BWC policies and procedures
Communicates with legal representatives, employers, claimants, etc.

Why Work for the State of Ohio

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. Our benefits package includes :

Medical Coverage

Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period

Paid time off, including vacation, personal, sick leave and 11 paid holidays per year

Childbirth, Adoption, and Foster Care leave

Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)

Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)

Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

Qualifications

To Qualify, You Must Clearly Demonstrate : Required Experience and / or Education

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

Or 24 mos. exp. 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 mos. exp. 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 mos. exp. 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 mos. exp. 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

. (

) Developed after employment

EEO & ADA Statement : The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.

The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request a reasonable accommodation due to disability, please contact

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Claim Specialist • Columbus, OH, US