Ohio BWC (official)
Cincinnati - BWC Fraud Analyst PN: 20066747
Ohio BWC (official), Springdale, Ohio, United States
2 days ago Be among the first 25 applicants
BWC’s core hours of operation are Monday‑Friday from 8:00 am to 5:00 pm; daily start/end times may vary by department. Most positions work on‑site at one of BWC’s seven offices across the state. BWC offers flex‑time schedules that allow an employee to begin as early as 7:00 am or as late as 8:30 am, based on operational need and supervisor approval.
What You’ll Be Doing
Act as the lead worker for the investigative team to develop action plans, prioritize cases, maintain case progression, and ensure proper investigative steps and safety concerns are addressed.
Review and critique reports of investigations completed by staff, ensuring accuracy, completeness, and thoroughness; determine if fraud has been established; write clear, concise professional correspondence and reports; monitor cases during the appeals process and inform appropriate entities of outcomes.
Communicate verbally and in writing to collaborate professionally with coworkers, injured workers, employers, legislators, health‑care providers, and the public.
Use the Fraud Management System (FMS), Universal Document System (UDS), Microsoft Excel, and other SID programs to analyze cases with analytical charting (e.g., flow charts and link analysis).
Conduct thorough claim reviews in CoreSuite, gather information, evaluate medical treatment appropriateness, monitor and document claim activities, research and interpret medical documentation, prepare BWC orders or IC motions, adjust benefit plans, declare over‑payment allocations, stop improper payments, et al., and prepare recovery packets.
Qualifications
54 months’ experience in a private insurance organization as a claims representative, criminal investigator, rehabilitation case manager, or equivalent, 6 months’ experience operating a personal computer, a valid driver’s license, and successful completion of a State Highway Patrol background check.
Alternative: completion of undergraduate core coursework in business, criminal justice, humanities, social & behavioral science, education or related field; 18 months’ experience in an insurance organization as a claims representative, criminal investigator, rehabilitation case manager, or equivalent; 6 months’ experience operating a personal computer; a valid driver’s license; and successful completion of a State Highway Patrol background check.
Alternative: 18 months’ experience as a Workers’ Compensation Claims Specialist (17‑722) or managing a caseload of workers’ compensation lost‑time disability claims, 6 months’ experience operating a personal computer, a valid driver’s license, and successful completion of a State Highway Patrol background check.
Alternative: 18 months’ experience as a BWC Fraud Investigator (26‑261). Must comply with Ohio Administrative Code Chapter 4501 and relevant LEADS security policies, including fingerprint‑based background checks within 30 days of employment.
Job Skills Investigation
Major Worker Characteristics Knowledge of:
Business, Criminal Justice, Humanities, Social & Behavioral Science Education or related field; BWC Policies & Procedures, Laws & Regulations related to Workers’ Compensation adjudication; applicable state and federal statutes, rules, and procedures for investigation, evidence gathering, and search & seizure; English; oral & written communication; public relations; interviewing techniques; customer service principles; fundamental math operations; standard business practices.
Skill in:
Personal computer use; word processing; database & spreadsheet software; analytical software used in fraud detection; surveillance equipment (e.g., 35 mm camera, camcorder, mini camera, undercover audio recording devices).
Ability to:
Communicate effectively and professionally with injured workers, employers, legislators, health‑care providers, and the public; make complex decisions regarding claims activity; read and understand medical reference manuals; write clear, concise professional correspondence and reports; collate and classify information about data, people or things; assess immediate situations and make split‑second decisions; respond to sensitive inquiries from contacts.
Organization: Workers’ Compensation
Agency Contact Name and Information: Matthew Palte – HCM Sr. Analyst, Matthew.P.2@bwc.ohio.gov
Unposting Date: November 16, 2025, 10:59 PM
Work Location: Cincinnati Claims Office
Primary Location: United States of America—OHIO—Hamilton County—Springdale
Compensation: $33.52 – $49.18 per hour
Schedule: Full‑time
Work Hours: 40 hours per week
Classified Indicator: Classified
Union: OCSEA
Primary Job Skill: Investigation
Technical Skills: Criminology/Criminal Justice
Professional Skills: Analysis, Ethics and Values, Teamwork, Time Management, Written Communication
Agency Overview 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, BWC provides 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 disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal‑opportunity employer. Employees can participate in and lead work groups, participate in online forums, and learn 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.
#J-18808-Ljbffr
BWC’s core hours of operation are Monday‑Friday from 8:00 am to 5:00 pm; daily start/end times may vary by department. Most positions work on‑site at one of BWC’s seven offices across the state. BWC offers flex‑time schedules that allow an employee to begin as early as 7:00 am or as late as 8:30 am, based on operational need and supervisor approval.
What You’ll Be Doing
Act as the lead worker for the investigative team to develop action plans, prioritize cases, maintain case progression, and ensure proper investigative steps and safety concerns are addressed.
Review and critique reports of investigations completed by staff, ensuring accuracy, completeness, and thoroughness; determine if fraud has been established; write clear, concise professional correspondence and reports; monitor cases during the appeals process and inform appropriate entities of outcomes.
Communicate verbally and in writing to collaborate professionally with coworkers, injured workers, employers, legislators, health‑care providers, and the public.
Use the Fraud Management System (FMS), Universal Document System (UDS), Microsoft Excel, and other SID programs to analyze cases with analytical charting (e.g., flow charts and link analysis).
Conduct thorough claim reviews in CoreSuite, gather information, evaluate medical treatment appropriateness, monitor and document claim activities, research and interpret medical documentation, prepare BWC orders or IC motions, adjust benefit plans, declare over‑payment allocations, stop improper payments, et al., and prepare recovery packets.
Qualifications
54 months’ experience in a private insurance organization as a claims representative, criminal investigator, rehabilitation case manager, or equivalent, 6 months’ experience operating a personal computer, a valid driver’s license, and successful completion of a State Highway Patrol background check.
Alternative: completion of undergraduate core coursework in business, criminal justice, humanities, social & behavioral science, education or related field; 18 months’ experience in an insurance organization as a claims representative, criminal investigator, rehabilitation case manager, or equivalent; 6 months’ experience operating a personal computer; a valid driver’s license; and successful completion of a State Highway Patrol background check.
Alternative: 18 months’ experience as a Workers’ Compensation Claims Specialist (17‑722) or managing a caseload of workers’ compensation lost‑time disability claims, 6 months’ experience operating a personal computer, a valid driver’s license, and successful completion of a State Highway Patrol background check.
Alternative: 18 months’ experience as a BWC Fraud Investigator (26‑261). Must comply with Ohio Administrative Code Chapter 4501 and relevant LEADS security policies, including fingerprint‑based background checks within 30 days of employment.
Job Skills Investigation
Major Worker Characteristics Knowledge of:
Business, Criminal Justice, Humanities, Social & Behavioral Science Education or related field; BWC Policies & Procedures, Laws & Regulations related to Workers’ Compensation adjudication; applicable state and federal statutes, rules, and procedures for investigation, evidence gathering, and search & seizure; English; oral & written communication; public relations; interviewing techniques; customer service principles; fundamental math operations; standard business practices.
Skill in:
Personal computer use; word processing; database & spreadsheet software; analytical software used in fraud detection; surveillance equipment (e.g., 35 mm camera, camcorder, mini camera, undercover audio recording devices).
Ability to:
Communicate effectively and professionally with injured workers, employers, legislators, health‑care providers, and the public; make complex decisions regarding claims activity; read and understand medical reference manuals; write clear, concise professional correspondence and reports; collate and classify information about data, people or things; assess immediate situations and make split‑second decisions; respond to sensitive inquiries from contacts.
Organization: Workers’ Compensation
Agency Contact Name and Information: Matthew Palte – HCM Sr. Analyst, Matthew.P.2@bwc.ohio.gov
Unposting Date: November 16, 2025, 10:59 PM
Work Location: Cincinnati Claims Office
Primary Location: United States of America—OHIO—Hamilton County—Springdale
Compensation: $33.52 – $49.18 per hour
Schedule: Full‑time
Work Hours: 40 hours per week
Classified Indicator: Classified
Union: OCSEA
Primary Job Skill: Investigation
Technical Skills: Criminology/Criminal Justice
Professional Skills: Analysis, Ethics and Values, Teamwork, Time Management, Written Communication
Agency Overview 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, BWC provides 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 disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal‑opportunity employer. Employees can participate in and lead work groups, participate in online forums, and learn 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.
#J-18808-Ljbffr