2 - Workers' Compensation Claims Specialist (PN 20068464 & 20068485)

What You'll Be Doing:

• Communicate, coordinate and collaborate with internal and external stakeholders to set return to work expectations.
• Perform initial/subsequent claims investigation and determination within prescribed timeframes.
• Evaluate information and issue orders, make claim allowance decisions in regard to Worker's Compensation law and/or policy develops, implements, customer care plan on all eligible claims through collaboration with MCOs.
• Address subsequent requests by parties to claim via due process notification, investigation, BWC orders and referrals to the Industrial Commission of Ohio.
• Maintain the various claims management systems correct claims information including claim reserve data elements.
• Reviews medical documentation and legal documentation and take appropriate action.
• Attends statewide, local meetings, team huddles; complete required BWC specific and State of Ohio trainings throughout the year.

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website ! Our benefits package includes:

• Medical Coverage
• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
• Public Retirement Systems ( such as OPERS, STRS, SERS, and HPRS ) & Optional Deferred Compensation ( Ohio Deferred Compensation )

*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

Qualifications

To Qualify You Must Clearly Demonstrate:

36 months experience working in private insurance organization as claims representative or equivalent position AND 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 AND successful completion of one typing course or demonstrate ability to type 35 words per minute.

OR 24 months experience 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 months experience 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 months experience 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 months experience 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.

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

Job Skills: Claims Examination