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Ohio BWC (official) · 1 day ago

(2) Columbus- Claims Specialist - PN: 20069246, 20069105

Columbus, OH

Full-time

Onsite

Entry, Mid Level

$25.77/hr - $33.52/hr

2+ years exp

Ohio BWC is a state agency dedicated to promoting a culture of safety and providing quality care for injured workers. The Claims Specialist will manage a caseload of Workers’ Compensation claims, communicate with various 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)

Process 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

Evaluates information & issues orders, makes claim allowance decisions in regard to Workers' Compensation law &/or policy develops, implements, customer care plan on all eligible claims through collaboration with MCOs (e.g. Return to Work), processes various types of compensation

Responds to customer inquiries

Follows Ohio Revised Code and BWC policies and procedures

Communicates with legal representatives, employers, claimants, etc

Qualification

Workers' Compensation ClaimsClaims ExaminationCustomer ServiceMicrosoft OfficeMedical TerminologyAttention 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

Or Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute

Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self-insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information, & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law)

Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations) &/or as BWC Employer Service Representative, 63521, (i.e., providing information & assistance &/or responding to complaints, questions & inquiries from customers regarding workers' compensation coverage, established binder/applications maintenance, demographics, supplemental & legal entities, manual classifications, debits/credits & payroll reports &/or various BWC programs & research & explain employer refunds, attorney general balances, payments made to policies &/or divided credits)

Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers' Compensation)

Or 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

Or equivalent of Minimum Class Qualifications For Employment noted above

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