WC Medical Claims Specialist (PN: 20068762)

About the role

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 7:00 am or as late as 8:30 am. Flex-time schedules are based on operational need and require supervisor approval.

Responsibilities

• Makes initial and subsequent claim determinations and issues orders as appropriate through phone contacts, written correspondence, and investigation.
• Reviews and gathers information necessary to identify claim severity; staffs more complex claims with supervisor, team nurses, and field service office staff.
• Sends Due Process notifications and reviews claim for supporting medical; refers claim for medical reviews if necessary and issues appropriate BWC orders.
• Creates cases for referrals to the Industrial Commission of Ohio for decisions as needed.
• Processes and maintains claim information, medical and legal documents within prescribed timeframes, and records information in system; updates and maintains tasks list.
• Responds orally and in writing to requests from injured workers, employers, providers, legal representatives, managed care organizations, and legislators.
• Documents claim transactions and activities in claim management system notes and establishes claim tasks for ongoing claim management.

Requirements

• 3 courses or 9 months training or 9 months experience in English composition or grammar.
• 3 courses or 9 months training or 9 months experience in accounting, bookkeeping or general business mathematics.
• 3 courses or 9 months training or 9 months experience in communication or public speaking; or 9 months experience involving contact with injured workers, employers, legislators, providers or their representatives and the public.
• Successful completion of one typing course or ability to type 35 words per minute.
• Or 12 months experience as Workers’ Compensation Claims Assistant (providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate and in compliance with bureau of workers compensation procedures; determining allowances using code manual ICD/CPT; taking appropriate action on self-insured claims; reconstructing lost claim files; assigning claim numbers and updating claim information; managing caseload of self-insured medical and disability claims to ensure compliance with Ohio Workers’ Compensation Law).
• Or 12 months experience as BWC Customer Service Representative (providing information/assistance to customers; answering complaints, questions and telephone inquiries or written correspondence from customers pertaining to claims status or procedures; reviewing and analyzing claims; referring customers to available community services; conducting telephone interviews with citizens reporting fraud allegations).

Skills

• Knowledge of: workers’ compensation laws, policies and procedures; eligibility criteria and procedures used for processing workers’ compensation medical only claims; principles of customer service; public relations; English grammar and spelling; oral and written business communication; fundamental mathematics; Workers’ Compensation standard business practices; interviewing techniques; internet search engines and navigation; medical terminology; medical diagnosis coding; Industrial Commission processes.
• Skill in: operation of a personal computer; typing; use of Microsoft Office software (Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (Workers’ Compensation claims management system, BWC Web Site, SharePoint); operation of office machinery (calculator, printer, copier, fax, phone); communication skills (listening, writing, reading, phone etiquette); use of internet.
• Ability to: define problems, collect data, establish facts and draw valid conclusions; read, access and understand medical reference manuals and reports; gather, collate and classify information about data, people, or things; communicate effectively and professionally; communicate on sensitive information and inquiries with injured workers, employers, providers or their representatives and the public; multitask by utilizing good organizational skills and time management; answer routine and technical inquiries from injured workers, employers, medical providers and the public; make proper referrals; diffuse potentially volatile situations; present information to others; work with a team; develop good rapport with internal and external customers; utilize ICD coding tools; generate properly formatted business correspondence; prioritize caseload based on performance goals; interpret Data Warehouse reports.

Benefits

BWC conducts an internal engagement survey on an annual basis. Employee comments include:

• “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.”

Pay

$24.88 per hour

Schedule

Full-time