Columbus - BWC Fraud Analyst Healthcare Fraud Investigative Specialist PN
Columbus - BWC Fraud Analyst Healthcare Fraud Investigative Specialist PN
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Job Description
What our employees have to say:
BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:
- BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.
- I have worked at several state agencies and BWC is the best place to work.
- Best place to work in the state and with a sense of family and support.
- I love the work culture helpfulness and acceptance Ive been embraced with at BWC.
- I continue to be impressed with the career longevity of our employees their level of dedication to service pride in their work and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.
If you are interested in helping BWC grow please click this link to read more and then come back to this job posting to submit your application!
What Youll Be Doing:
- Acts as primary lead in the investigation of complex health care fraud cases.
- Independently receives analyzes & responds to a caseload of complex allegations of Workers Compensation Fraud (e.g. complex health care fraud schemes conspiracy cases multijurisdictional cases).
- Acts as alead worker (i.e. provides work direction) over staff who may assist with assigned HCF investigations and assists &/or conducts joint investigations with local state & federal law enforcement agencies (e.g. Health & Human Services; Federal Bureau of Investigation; Internal Revenue Service; Postal Inspection).
- Acts as a lead worker over new hires as a Field Training Officer (FTO).
- Serves as LEADS TAC (when needed).
- Acts as an evidence technician.
- Leads the administrative and technical aspects of the health care fraud undercover operations.
- Takes responsibility for records & information management (RIM) policies & procedures.
- Works closely with HCPT Management in reviewing investigative data trends impacting the success of health care fraud investigations.
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 ADA Coordinator Kathleen Bourke ator by email to:
BWC OCSEA Selection Rights:
This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before nonbargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.
Transportation:
Position may require travel; therefore persons occupying this position must be able to provide own transportation &/or legally operate a stateowned vehicle.
Educational Transcripts:
For any educational achievements to be considered during the screening process you must at least attach an unofficial transcript that details the coursework you have completed.
All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.
Background Check:
Prior to an offer of employment the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.
54 mos. exp. in private insurance organization as claims representative criminal investigator rehabilitation case manager or equivalent position; 6 mos. exp. in operation of personal computer; valid drivers license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment.
Or completion of undergraduate core coursework in business criminal justice humanities social & behavioral science education or related field; 18 mos. exp. in insurance organization as claims representative criminal investigator rehabilitation case manager or equivalent position; 6 mos. exp. in operation of personal computer; valid drivers license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment .
Or 18 mos. exp. as Workers Compensation Claims Specialist 16722 or managing caseload of workers compensation losttime disability claims which involved making decision to allow or deny claim verifying appropriateness of medical treatment & charges preauthorized medical treatment equipment supplies & special travel arrangements researching negotiating authorizing & issuing settlement of claims &/or conducting field inquiries to accurately assess claim information & resolving disputed condensability & benefit level for Ohio Bureau Of Workers Compensation; 6 mos. exp. in operation of personal computer; valid drivers license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment.
Or 18 mos. exp. as BWC Fraud Investigator 26261. Note: Pursuant to Ohio Administrative Code Chapter 4501 users of system shall adhere to policies & guidelines published in NCIC operating manual CJIS security policy LEADS operating manual LEADS security policy newsletters & administrative messages from LEADS all of which are either available on ODPS/LEADS intranet or disseminated to LEADS agencies; pursuant to LEADS security policy (revised 05/07/03 state & national fingerprintbased record checks must be conducted within 30 days of initial employment or assignment of all personnel including appropriate IT personnel having access to LEADS or to records storage areas containing CCH/II data; minimum check must include submission of both a State of Ohio BCI& I card & an FBI applicant fingerprint card; both completed applicant fingerprint cards must be submitted by employing agency to State of Ohio Bureau of Criminal Identification & Investigation for processing & forwarding to Federal Bureau of Investigation; record of this check must be kept by employing agency & made available to LEADS upon request; fingerprint card returned by Ohio BCI&I is sufficient documentation. Pursuant to Ohio Administrative Code Chapter 4501 terminal agency shall conduct a complete background investigation of all terminal operators including but not limited to: an applicant fingerprint card submission to BCI&I & FBI an inquiry of state & national arrest & fugitive files; terminal agency is required to notify CTO of any applicants criminal record; existence of a criminal record may result in denial of access.
Job Skills: Investigation
Major Worker Characteristics:
* Developed after employment.
A Little About Us:
With roughly 1500 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 online 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.
The State of Ohio is a drugfree workplace which prohibits the use of (recreational /nonmedical cannabis). Please note this position may be subject to additional restrictions pursuant to the State of Ohio DrugFree Workplace Policy (HR39 and as outlined in the posting.
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services activities programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
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 fulltime and parttime employees*. For a list of all the State of Ohio Benefits visit ourTotal Rewards website! 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.
Required Experience:
IC
Employment Type
Full-Time
