Cincinnati- Claims Specialist PN

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 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.

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 the ADA mailbox:

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.

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:

• 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.

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.

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.

To Qualify You MustClearlyDemonstrate:
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