Technical Claims Specialist - PN: 20069293

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 perform work on-site at one of BWC’s 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 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 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.

Responsibilities

• Conduct quality assurance audits of claims and operational processes; identify trends and prepare findings.
• Monitor compliance with injury management policies and ensure consistent, accurate claims practices statewide.
• Support updates to policies, procedures, and audit tools; recommend and help implement operational improvements.
• Provide guidance and clarification to staff and supervisors on policies, procedures, system processes, and operational expectations.
• Participate in or lead statewide initiatives aimed at improving service quality, consistency, and customer satisfaction.
• Identify staff skill gaps and collaborate on training recommendations to strengthen performance across service offices.
• Support administrative tasks, respond to inquiries, and assist with operational research as needed.

Requirements

• 36 months experience managing lost-time claims and/or medical-only claims serving as primary decision maker to include making initial determination of claim, having overall responsibility and accountability of claim, and management of claim to desired outcome.
• OR 2 years training or 2 years experience in adjusting insurance claims or medical case management in an insurance-related field, or rehabilitation case management in an insurance-related field; 1 course or 3 months experience in employee training and development; 2 courses or 6 months experience in public speaking or communication skills; 1 course or 3 months experience in business/professional writing, English composition, or written communication.
• OR completion of undergraduate core program in business administration, public administration, insurance, risk management, education, communication, social or behavioral science, nursing or health administration (e.g., rehabilitation counseling) or related field of study; 1 course or 3 months experience in auditing principles and procedures; 1 course or 3 months experience in employee training and development; 1 course or 3 months experience in speech and/or oral communication or public speaking; 1 course or 3 months experience in business/professional writing, English composition, or written communication.
• OR 36 months experience as supervisor within Ohio Bureau of Workers' Compensation responsible for implementation, evaluation, and monitoring of technical programs (e.g., new or revised claims processing program, programs to identify and deter fraudulent claims activity, premium discount program).
• OR equivalent of Minimum Class Qualifications for Employment noted above.

Skills

Knowledge of:

• Policies and procedures related to claims operations, risk, safety and hygiene, loss prevention, medical and managed care.
• State and federal laws governing workers’ compensation.
• Management; labor relations; manpower planning; public relations; government structure and process (BWC).
• Interviewing; BWC laws; budgeting; training; loss-prevention principles; BWC programs; OSHA compliance.

Skill in:

• Management of diverse field operations and staff; leadership; communicating with diverse audiences; directing change; creativity and innovation; operation of a PC.

Ability to:

• Interpret extensive variety of technical and complex material in verbal and written forms.
• Prepare and deliver professional presentations before specialized audiences and public.
• Develop complex reports pertaining to claims, risk, safety and hygiene, medical and managed care.
• Handle highly confidential and sensitive matters with all contacts.
• Strategize for optimum efficiency; practice innovation and be creative in a government environment.
• Delegate appropriately; identify and manage staff performance variances; direct programs.
• Use statistical analysis; analyze customer satisfaction.

Pay

$40.40 - $57.67 per hour

Schedule

Full-time, classified position. Flex-time schedules available with supervisor approval, allowing start times between 7:00am and 8:30am based on operational need.

Agency Overview

With roughly 1,500 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