WC Claims Specialist (PN: 20068419, 20068729, 20069075, 20069106 & 20069204)

About the role

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.

Responsibilities

• 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).
• Processes 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.
• Responds to customer inquiries
• Follows Ohio Revised Code and BWC policies and procedures
• Communicates with legal representatives, employers, claimants, etc.

Requirements

• 36 mos. exp. in 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) in order to determine eligibility for benefits, approve or deny claims, resolve benefit-related disputes, calculate benefit payments, &/or perform similar benefit-related duties.
• Or completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field;
• 12 mos. exp. in 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) in order to determine eligibility for benefits, approve or deny claims, resolve benefit-related disputes, calculate benefit payments &/or perform similar benefit-related duties.
• Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 &/or BWC Customer Service Representative, 64451, &/or BWC Employer Service Representative, 63521.
• Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721.
• Or any combination of at least 36 mos. exp. in position requiring evaluation of medical or public assistance benefits &/or as Workers' Compensation Claims Assistant, 16720, &/or as BWC Customer Service Representative, 64451 &/or as BWC Employer Service Representative, 63521.
• Equivalent of Minimum Class Qualifications For Employment noted above.

Qualifications

Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment.

Skills

• Claims Examination
• Customer Service
• Major Worker Characteristics
• Knowledge of: workers' compensation laws, policies & procedures*
• Knowledge of: eligibility criteria & procedures used for processing workers' compensation claims*
• Knowledge of: English grammar & spelling
• Knowledge of: oral & written business communication
• Knowledge of: public relations*
• Knowledge of: addition, subtraction, multiplication, division, fractions, decimals & percentages
• Knowledge of: interviewing techniques
• Knowledge of: internet search engines & navigation
• Knowledge of: medical terminology
• Knowledge of: medical diagnosis coding*
• Knowledge of: Industrial Commission processes*
• Knowledge of: claims reserving*
• Skill in: operation of a personal computer
• Skill in: typing
• Skill in: use of Microsoft Office software (e.g., Outlook, Word, Excel, Access, PowerPoint)
• Skill in: use of BWC-specific software (e.g., Workers’ Compensation Claims Management System, Intrafin, FMS fraud system)*
• Skill in: operation of office machinery (e.g. calculator, printer, copier, fax, phone)
• Skill in: communication skills (e.g., listening, writing, reading, phone etiquette)
• Skill in: use of internet
• Skill in: Ability to: define problems, collect data, establish facts, & draw valid conclusions
• Skill in: read & understand medical reference manuals & reports, gather, collate, & classify information about data, people, or things
• Skill in: respond to sensitive inquiries from & contacts with injured workers, employers, providers or their representatives, & the public
• Skill in: answer routine & technical inquiries from injured workers, employers, medical providers & public*
• Skill in: make proper referrals (within agency & external sources)*
• Skill in: diffuse potentially volatile situations
• Skill in: present information to others
• Skill in: work with a team
• Skill in: use International Classification of Diseases (ICD) coding manuals/system*
• Skill in: generate properly formatted business correspondence
• Skill in: read and understand compensation payment plan screens*, interpret Cognos reports*

Skills

• Major Worker Characteristics
• Attention to Detail
• Critical Thinking
• Teamwork
• Time Management
• Written Communication

Job Skills

• Claims Examination
• Customer Service
• Major Worker Characteristics
• Knowledge of: workers' compensation laws, policies & procedures*
• Knowledge of: eligibility criteria & procedures used for processing workers' compensation claims*
• Knowledge of: English grammar & spelling
• Knowledge of: oral & written business communication
• Knowledge of: public relations*
• Knowledge of: addition, subtraction, multiplication, division, fractions, decimals & percentages
• Knowledge of: interviewing techniques
• Knowledge of: internet search engines & navigation
• Knowledge of: medical terminology
• Knowledge of: medical diagnosis coding*
• Knowledge of: Industrial Commission processes*
• Knowledge of: claims reserving*
• Skill in: operation of a personal computer
• Skill in: typing
• Skill in: use of Microsoft Office software (e.g., Outlook, Word, Excel, Access, PowerPoint)
• Skill in: use of BWC-specific software (e.g., Workers’ Compensation Claims Management System, Intrafin, FMS fraud system)*
• Skill in: operation of office machinery (e.g. calculator, printer, copier, fax, phone)
• Skill in: communication skills (e.g., listening, writing, reading, phone etiquette)
• Skill in: use of internet
• Skill in: Ability to: define problems, collect data, establish facts, & draw valid conclusions
• Skill in: read & understand medical reference manuals & reports, gather, collate, & classify information about data, people, or things
• Skill in: respond to sensitive inquiries from & contacts with injured workers, employers, providers or their representatives, & the public
• Skill in: answer routine & technical inquiries from injured workers, employers, medical providers & public*
• Skill in: make proper referrals (within agency & external sources)*
• Skill in: diffuse potentially volatile situations
• Skill in: present information to others
• Skill in: work with a team
• Skill in: use International Classification of Diseases (ICD) coding manuals/system*
• Skill in: generate properly formatted business correspondence
• Skill in: read and understand compensation payment plan screens*, interpret Cognos reports*

Agency Contact Name and Information

Mia Truss-Davis - HCM Sr. Analyst
Mia.T.1@bwc.ohio.gov

Unposting Date

Aug 4, 2026, 8:59:00 PM

Work Location

Columbus

Service Office

Primary Location

United States of America-OHIO-Franklin County-Columbus

Compensation

$26.54 - $34.53

Schedule

Full-time

Work Hours

40

Classified Indicator

Classified

Union

OCSEA

Technical Skills

• Claims Examination
• Customer Service

Professional Skills

• Attention to Detail
• Critical Thinking
• Teamwork
• Time Management
• Written Communication

Agency Overview

A Little About Us: 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 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.