State of Ohio
(2) Columbus- Claims Specialist - PN: 20069246, 20069105
State of Ohio, Columbus, Ohio, United States, 43224
Job Description
Columbus – Claims Specialist – PN: 20069246, 20069105 (2600002Z)
Overview The Ohio Bureau of Workers' Compensation Human Resources invites applicants to support Ohio workers by managing workers' compensation claims, ensuring quality medical and pharmacy care, and promoting safety at work and home.
What You’ll Be Doing:
Manage a caseload of workers’ compensation claims, communicating and coordinating with internal and external stakeholders (e.g., Disability Management Coordinator, Medical Service Specialist, Managed Care Organization, Employer Management team, Safety & Hygiene, injured workers, employers, Third Party Administrators & rehabilitation personnel) to set return-to-work expectations.
Perform initial and subsequent claims investigation and determination within prescribed timeframes, contacting parties involved in the claim process and completing investigation to gather information pertinent to claims management (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, including Temporary Total Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, and Lump Sum Advancement requests; address subsequent requests by parties to claim through due process notification, investigation, BWC orders & referrals to the Industrial Commission of Ohio.
Evaluate information and issue orders, make claim allowance decisions in regard to workers' compensation law and/or policy, develop and implement customer care plan for all eligible claims through collaboration with MCOs (e.g., Return to Work).
Respond to customer inquiries and follow Ohio Revised Code and BWC policies and procedures.
Communicate with legal representatives, employers, claimants, and others.
Why Work for the State of Ohio We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a full list of benefits, visit the Total Rewards website.
Benefits
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 System membership (OPERS, STRS, SERS, HPRS) and optional deferred compensation (Ohio Deferred Compensation)
Qualifications
36 months experience working in private insurance organization as claims representative or equivalent; successful completion of one typing course or 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 ability to type 35 words per minute.
Or 24 months experience as Workers' Compensation Claims Assistant, 16720.
Or 24 months experience as BWC Customer Service Representative, 64451, or as BWC Employer Service Representative, 63521.
Or 12 months experience as Workers' Compensation Medical Claims Specialist, 16721.
Or any combination of at least 36 months experience working in private insurance organization as claims representative or equivalent and/or as Workers' Compensation Claims Assistant, 16720 and/or as Workers' Customer Service Representative, 64451 and/or as Workers’ Compensation Employer Service Representative, 63521.
Or equivalent of Minimum Class Qualifications for Employment noted above (job skills: Claims Examination).
Major Worker Characteristics 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 (Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (Workers’ Compensation Claims Management System, Intrafin, FMS fraud system); 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, & draw valid conclusions; read & understand medical reference manuals & reports; gather, collate, & classify information; respond to sensitive inquiries; make proper referrals; diffuse potentially volatile situations; present information to others; work with a team.; use ICD coding manuals/system; generate properly formatted business correspondence; read and understand compensation payment plan screens.; interpret Cognos reports.
EEO & ADA Statement The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order. The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request a reasonable accommodation due to disability, please contact the ADA mailbox: BWCADA@bwc.ohio.gov.
Background Check Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.
Drug-Free Workplace The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). This position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39).
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Overview The Ohio Bureau of Workers' Compensation Human Resources invites applicants to support Ohio workers by managing workers' compensation claims, ensuring quality medical and pharmacy care, and promoting safety at work and home.
What You’ll Be Doing:
Manage a caseload of workers’ compensation claims, communicating and coordinating with internal and external stakeholders (e.g., Disability Management Coordinator, Medical Service Specialist, Managed Care Organization, Employer Management team, Safety & Hygiene, injured workers, employers, Third Party Administrators & rehabilitation personnel) to set return-to-work expectations.
Perform initial and subsequent claims investigation and determination within prescribed timeframes, contacting parties involved in the claim process and completing investigation to gather information pertinent to claims management (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, including Temporary Total Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, and Lump Sum Advancement requests; address subsequent requests by parties to claim through due process notification, investigation, BWC orders & referrals to the Industrial Commission of Ohio.
Evaluate information and issue orders, make claim allowance decisions in regard to workers' compensation law and/or policy, develop and implement customer care plan for all eligible claims through collaboration with MCOs (e.g., Return to Work).
Respond to customer inquiries and follow Ohio Revised Code and BWC policies and procedures.
Communicate with legal representatives, employers, claimants, and others.
Why Work for the State of Ohio We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a full list of benefits, visit the Total Rewards website.
Benefits
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 System membership (OPERS, STRS, SERS, HPRS) and optional deferred compensation (Ohio Deferred Compensation)
Qualifications
36 months experience working in private insurance organization as claims representative or equivalent; successful completion of one typing course or 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 ability to type 35 words per minute.
Or 24 months experience as Workers' Compensation Claims Assistant, 16720.
Or 24 months experience as BWC Customer Service Representative, 64451, or as BWC Employer Service Representative, 63521.
Or 12 months experience as Workers' Compensation Medical Claims Specialist, 16721.
Or any combination of at least 36 months experience working in private insurance organization as claims representative or equivalent and/or as Workers' Compensation Claims Assistant, 16720 and/or as Workers' Customer Service Representative, 64451 and/or as Workers’ Compensation Employer Service Representative, 63521.
Or equivalent of Minimum Class Qualifications for Employment noted above (job skills: Claims Examination).
Major Worker Characteristics 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 (Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (Workers’ Compensation Claims Management System, Intrafin, FMS fraud system); 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, & draw valid conclusions; read & understand medical reference manuals & reports; gather, collate, & classify information; respond to sensitive inquiries; make proper referrals; diffuse potentially volatile situations; present information to others; work with a team.; use ICD coding manuals/system; generate properly formatted business correspondence; read and understand compensation payment plan screens.; interpret Cognos reports.
EEO & ADA Statement The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order. The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request a reasonable accommodation due to disability, please contact the ADA mailbox: BWCADA@bwc.ohio.gov.
Background Check Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.
Drug-Free Workplace The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). This position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39).
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