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Ohio BWC (official) · 1 day ago

Canton - WC Claims Specialist - PN: 20069850, 20068366, 20068401 & 20068483

North Canton, OH

Full-time

Onsite

Mid Level

$25.77/hr - $33.52/hr

3+ years exp

Ohio BWC is a state agency focused on promoting workplace safety and providing insurance for workplace injuries. They are seeking a WC Claims Specialist to manage Workers’ Compensation claims, coordinate with stakeholders, and ensure compliance with relevant laws and policies.

Employee BenefitsInsuranceTraining

Comp. & Benefits

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

Qualification

Claims ExaminationWorkers' Compensation LawsMicrosoft OfficeMedical TerminologyCustomer ServiceAttention to DetailCritical ThinkingTeamworkTime ManagementWritten Communication

Required

36 mos. exp. working in private insurance organization as claims representative or equivalent position

successful completion of one typing course or demonstrate ability to type 35 words per minute

Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field

24 mos. exp. as Workers' Compensation Claims Assistant, 16720

24 mos. exp. as BWC Customer Service Representative, 64451

24 mos. exp. as BWC Employer Service Representative, 63521

12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721

any combination of at least 36 mos. exp. 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

equivalent of Minimum Class Qualifications For Employment noted above

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

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 internet

Ability to: define problems, collect data, establish facts, & draw valid conclusions; read & understand medical reference manuals & reports, gather, collate, & 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; make proper referrals (within 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

Company

Ohio BWC (official)

BWC helps thousands of injured workers and their employers each year by providing support, resources, and services to ensure workplace safety and recovery.

Founded in 1912

Columbus, Ohio, USA

1001-5000 employees