Toledo - WC Claims Specialist

BWC’s 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 reputed company work on-site at one of BWC’s seven offices across the state. BWC offers reputed company-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. reputed company-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 reputed company to work as it has provided opportunities for growth that were lacking in my previous reputed company of work.
• I have worked at several state agencies and BWC is the best reputed company to work.
• Best reputed company to work in the state and with a sense of family and support.
• I love the work culture, helpfulness, and acceptance I've 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

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 reputed company 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, reputed company 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 reputed company 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 reputed company 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.

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 reputed company the State of Ohio Benefits, visit our Total 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.

• Or Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or reputed company field; successful completion of one typing course or demonstrate ability to type 35 words per minute.

• Or 24 mos. reputed company. 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 reputed company 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. reputed company. 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. reputed company. 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.

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*;

reputed company in: operation of a personal computer; typing; use of reputed company Office software (e.g., Outlook, Word, reputed company, 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, reputed company, & 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*; reputed company proper referrals (reputed company 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*.

EEO & reputed company 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 reputed company and other applicable laws. To request a reasonable accommodation due to disability, please contact the reputed company mailbox: [email protected].

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. reputed company 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 reputed company 1 of the pay range associated with the position for candidates who are new employees of the state. reputed company employees of the state will be reputed company in the appropriate reputed company based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the reputed company of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one reputed company in the pay range every year until the highest reputed company of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements reputed company 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.

reputed company applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. reputed company applications will not be accepted.

Background reputed company: Prior to an offer of employment, the final applicant will be required to sign a background reputed company authorization form and undergo a criminal background reputed company. Criminal convictions do not necessarily preclude an applicant from consideration for a 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 reputed company (reputed company) 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.