Toledo - BWC Fraud Analyst - PN:
Toledo - BWC Fraud Analyst - PN:
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Job Description
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*. 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.
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.
The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39) and as outlined in the posting.
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 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.
54 mos. private insurance organization as claims representative criminal investigator rehabilitation case manager or equivalent position; 6 mos. 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. insurance organization as claims representative criminal investigator rehabilitation case manager or equivalent position; 6 mos. 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 lost-time disability claims which involved making decision to allow or deny claim verifying appropriateness of medical treatment & charges pre-authorized 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. 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 fingerprint-based 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:
Knowledge of Business Criminal Justice Humanities Social & Behavioral Science Education or related field; BWC Policies & Procedures* Laws & Regulations related to Adjudication & Maintenance of Workers Compensation Claims*& policies; Agency State &/or Federal Statutes rules regulations & procedures applicable to investigation evidence gathering & search & seizure*; English; oral & written communication; Public relations; interviewing techniques; principles of customer service; fundamental math operations; standard business practices.
Skill in use of personal computer; word processor*; data base & spreadsheet software*; analytical software used in Fraud Detection*; surveillance equipment (e.g. digital camera video camera mini camera; undercover audio recording devices)*
Ability to communicate effectively & professionally with injured workers employers legislators health care providers & public; make complex decisions regarding claims & policy activity; read & understand medical policy reference manuals; write clear concise & professional correspondence & reports; collate & classify information about data people or things; assess immediate situation & make split second decisions; respond to sensitive inquiries from & contacts with injured workers employers legislators health care providers & public.
BWCs core hours of operation are Monday-Friday from 8:00am to 5:00pm however daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWCs seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.
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:
- Acting as the lead worker for the investigative team to develop investigative action plans; prioritizing cases maintaining case progression and ensuring proper investigative steps and safety concerns are being addressed.
- Reviewing/critiquing reports of investigation completed by investigative staff & ensuring accuracy completeness & thoroughness; determining if fraud has been established & when applicable writing clear concise & professional correspondence & reports; monitoring investigative cases throughout the appeals process & informing appropriate entities of the outcome.
- Communicating both verbally and in writing to effectively & professionally collaborate with coworkers injured workers employers legislators health care providers & public.
- Using the Fraud Management System (FMS) Universal Document System (UDS) Microsoft Excel and other SID programs to effectively analyze cases utilizing analytical charting (e.g. flow charts & link analysis);
- Conducting thorough policy and claim reviews in Core Suite to gather information & evaluate the appropriateness of manual classifications payroll reporting policy coverage preparing/requesting specific internal BWC actions based on investigation results; adjusting policies calculating inputting and adjusting premium & actuarial savings totals.
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 at or 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 non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.
Salary Information:
Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months assuming job performance is acceptable. Thereafter an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.
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.
Required Experience:
IC
Employment Type
Full-Time
