Claims Examiner 3 PN

Formal education in arithmetic that includes addition subtraction multiplication division fractions decimals & percentages & in reading writing & speaking common English vocabulary; 6 mos. trg. or 6 mos. examining claims eligibility criteria departmental policies & procedures & applicable laws required to process workers compensation claims; 3 mos. trg. or 3 mos. medical terminology.

-Or 6 mos. exp. as Claims Examiner 2 16792.

-Or equivalent of Minimum Class Qualifications for Employment noted above.

Job Skills: Claims Examination

Technical Skills:Customer Service Medical Terminology

Professional Skills: Attention to Detail Proofreading Time Management Written Communication

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.

Our mission is to serve injured workers and Ohio employers through expeditious and impartial resolution of issues arising from workers compensation claims and through the establishment of adjudication policy.

The Ohio Industrial Commission is seeking an experience claims examiner with a customer focused background who can handle assigned claims following agency guidelines and procedures someone who can adapt to change and remain professional while working with OIC customers.

The selected individual must have strong customer service skills must pay attention to details when reviewing claims and produce accurate work product and have the ability to multi-task prioritize and manage time effectively.

Under general supervision reviews exam reports for medical sufficiency using personal computer applications (CAS ECM Case Manager SharePoint ICON BWC applications):data retrieval verification resolution tracking & organization.

• Reviews issues according to established Workers Compensation laws and Industrial Commission rules policies and procedures
• Communicates with OIC specialist and office staff
• Reviews/analyzes claim documents and images to determine pertinent data (statements of facts claims allowances medical evidence disability factors specialist exam type etc.)
• Re-indexes and proofreads documents to ensure an accurate specialist packet and hearing folder
• Creates medical examination work sheets and/or electronic folders
• Determines number of exam(s) needed and specialty type(s)
• Creates medical examination work sheets and/or electronic folders
• Determines number of exams needed and specialty
• Captures issues tracks PCNs and updates claim/exam information (addresses risk and representative changes allowances/disallowances etc.) in CAS
• Reconciles delayed medical reports
• Processes incoming mail and faxes
• Determines whether supporting medical evidence is sufficient & refers for dismissal if lacking
• Reviews & documents information necessary to compose & write or type statement of facts
• Prepares 1st and 2nd level claims issues for hearing and hearing officer review.

See the attached position description for more details regarding this position.

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.

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.

This position is filled through an assessment consisting of a computer-based test and structured interview. The computer-based test will be administered in person at the William Green Building in Columbus Ohio. The structured interview will be held in person in the Columbus Regional office.

This is an on-site position and in-office presence is required.

The hourly wage for this position is not negotiable. For applicants who are not current State of Ohio employees the starting wage will be the hourly rate listed on this posting. Successful employees will move up a step in the salary range within one year and in most cases within four to six months with subsequent step increases occurring annually.

For internal applicants the position will be filled pursuant to legislation or the provision of the OCSEA/AFSCME Contract.

ADA Statement: The Industrial Commission 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. To request a reasonable accommodation due to a disability please contact the ADA Coordinator at (voice) or by email to: as-soon-as possible but at least 14 days prior to the scheduled event.

Background Check Information Statement: The final candidate selected for the position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicants prior criminal convictions will be made before excluding an applicant from consideration.