Toledo - WC Claims Specialist (PN: 20069733)

Schedule

BWC’s core hours of operation are Monday–Friday from 8:00 am to 5:00 pm. Daily start/end times may vary based on operational need. Flex-time schedules allow employees to begin as early as 7:00 am or as late as 8:30 am, subject to supervisor approval and operational need. Most positions are on-site at one of BWC’s seven offices across the state.

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

• Manages a caseload of Workers’ Compensation claims.
• Communicates, coordinates, and collaborates with internal and external stakeholders (e.g., Disability Management Coordinator, Medical Service Specialist, Managed Care Organization, Employer Management team, Safety & Hygiene, injured workers, employers, Third Party Administrators, and rehabilitation personnel) to set return-to-work expectations.
• Performs initial and subsequent claims investigation and determination within prescribed timeframes:
  • Contacts parties involved in the claim process.
  • Completes investigation during initial claim development to determine information pertinent to management of the claim (e.g., jurisdiction, coverage, causality, compensability, claim data accuracy, current work status of claimant, job description, salary continuation, physical demands of job, and work history of claimant).
• Processes various types of compensation ranging from Temporary Total Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests.
• Addresses subsequent requests by parties to the claim via due process notification, investigation, BWC orders, and referrals to the Industrial Commission of Ohio.
• Responds to customer inquiries.
• Follows Ohio Revised Code and BWC policies and procedures.
• Communicates with legal representatives, employers, claimants, etc.

Requirements

36 months of experience in a position requiring evaluation of medical or public assistance benefits (e.g., health insurance benefits, disability benefits, workers’ compensation benefits, unemployment benefits, public assistance benefits for food subsidies) to determine eligibility for benefits, approve or deny claims, resolve benefit-related disputes, calculate benefit payments, and/or perform similar benefit-related duties.

OR completion of undergraduate core coursework in business, humanities, social & behavioral science, education, or related field; plus 12 months of experience in a position requiring evaluation of medical or public assistance benefits as described above.

OR 24 months of experience as a Workers' Compensation Claims Assistant (16720), BWC Customer Service Representative (64451), and/or BWC Employer Service Representative (63521).

OR 12 months of experience as a Workers' Compensation Medical Claims Specialist (16721).

OR any combination of at least 36 months of experience in a position requiring evaluation of medical or public assistance benefits and/or as a Workers' Compensation Claims Assistant (16720), BWC Customer Service Representative (64451), and/or BWC Employer Service Representative (63521).

OR equivalent of the Minimum Class Qualifications for Employment noted above. Note: Classification may require use of a proficiency demonstration to determine minimum class qualifications for employment.

Skills

Knowledge of:

• Workers’ compensation laws, policies, and procedures.
• Eligibility criteria and procedures used for processing workers’ compensation claims.
• English grammar and spelling.
• Oral and written business communication.
• Public relations.
• Addition, subtraction, multiplication, division, fractions, decimals, and percentages.
• Interviewing techniques.
• Internet search engines and 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 the internet.

Ability to:

• Define problems, collect data, establish facts, and draw valid conclusions.
• Read and understand medical reference manuals and reports.
• Gather, collate, and classify information about data, people, or things.
• Respond to sensitive inquiries from and contacts with injured workers, employers, providers or their representatives, and the public.
• Answer routine and technical inquiries from injured workers, employers, medical providers, and the public.
• Make proper referrals (within agency and 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.

Pay

$26.54 – $34.53 per hour.

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