State of Ohio
Workers' Compensation Claims Specialist
Location:
Lausche Building 615 West Superior Avenue Cleveland 44113-1879, United States of America
Compensation:
$25.77 - $33.52 per hour
Schedule:
Full-time, 40 hours per week
Primary Job Skill:
Claims Examination
Organization Workers' Compensation
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, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.
Job Core Hours BWC’s core hours of operation are Monday-Friday from 8:00 am to 5:00 pm, with flexible start times (7:00 am – 8:30 am) based on operational need and supervisor approval.
What You’ll Be Doing
Manage a caseload of Workers’ Compensation claims, communicating, coordinating, and collaborating with internal and external stakeholders to set return-to-work expectations.
Perform initial and subsequent claims investigation and determination within prescribed timeframes, contacting parties involved and completing investigations to determine jurisdiction, coverage, causality, compensability, claim data accuracy, and claimant work status.
Process various types of compensation (Temporary Total, Wage Loss, Permanent Partial, Percentage of Permanent Partial, Living Maintenance, Lump Sum Advancement requests) and address subsequent requests via due process notification, investigation, BWC orders, and referrals to the Industrial Commission of Ohio.
Respond to customer inquiries and communicate with legal representatives, employers, claimants, and other stakeholders.
Follow Ohio Revised Code and BWC policies and procedures.
Why Work for the State of Ohio We provide a variety of quality, competitive benefits to eligible full‑time and part‑time employees. Benefits include:
Medical coverage
Free dental, vision, and basic life insurance premiums after the eligibility period
Paid time off (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)
Public retirement systems (OPERS, STRS, SERS, HPRS) and optional deferred compensation (Ohio Deferred Compensation)
Qualifications Experience:
36 months working in private insurance organization as claims representative or equivalent, or completing a typing course with 35 wpm, OR
Undergraduate core coursework in business, humanities, social & behavior science, education or related field with a typing course of 35 wpm, OR
24 months as Workers' Compensation Claims Assistant, 16720, OR as BWC Customer Service Representative, 64451, OR as BWC Employer Service Representative, 63521, OR
12 months as Workers' Compensation Medical Claims Specialist, 16721, OR
Any combination totaling at least 36 months of relevant experience.
Job Skills:
Claims Examination
Major Worker Characteristics Knowledge:
Workers' compensation laws, policies & procedures; eligibility criteria and processes; English grammar & spelling; oral & written business communication; public relations; math; interviewing techniques; internet search; medical terminology & coding; Industrial Commission processes; claims reserving.
Skills:
Operation of personal computer; typing; Microsoft Office; BWC-specific software (Claims Management System, Intrafin, FMS fraud system); office machinery; communication; internet.
Abilities:
Define problems, collect and analyze data, respond to inquiries, make referrals, diffuse volatile situations, present information, work with a team, use ICD coding, generate business correspondence, interpret reports.
Supplemental Information EEO & ADA Statement:
The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees based on 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 reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox eeodept@bwc.ohio.gov.
BWC OCSEA Selection Rights:
This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members.
Salary Information:
Hourly wage is expected to be paid at step 1 of the pay range for new state employees. Current employees will be placed at the appropriate step. Movement to the next step occurs after six months (roughly 4% increase) and annually thereafter. June adjustments may apply.
Educational Transcripts:
Unofficial transcripts detailing completed coursework must be attached.
Application Process:
All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.
Background Check:
Prior to an offer, the final applicant will sign a background check authorization form and undergo a criminal background check.
Drug-Free Workplace:
The State of Ohio is a drug-free workplace. This position may be subject to additional restrictions per the State of Ohio Drug-Free Workplace Policy (HR‑39).
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Lausche Building 615 West Superior Avenue Cleveland 44113-1879, United States of America
Compensation:
$25.77 - $33.52 per hour
Schedule:
Full-time, 40 hours per week
Primary Job Skill:
Claims Examination
Organization Workers' Compensation
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, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.
Job Core Hours BWC’s core hours of operation are Monday-Friday from 8:00 am to 5:00 pm, with flexible start times (7:00 am – 8:30 am) based on operational need and supervisor approval.
What You’ll Be Doing
Manage a caseload of Workers’ Compensation claims, communicating, coordinating, and collaborating with internal and external stakeholders to set return-to-work expectations.
Perform initial and subsequent claims investigation and determination within prescribed timeframes, contacting parties involved and completing investigations to determine jurisdiction, coverage, causality, compensability, claim data accuracy, and claimant work status.
Process various types of compensation (Temporary Total, Wage Loss, Permanent Partial, Percentage of Permanent Partial, Living Maintenance, Lump Sum Advancement requests) and address subsequent requests via due process notification, investigation, BWC orders, and referrals to the Industrial Commission of Ohio.
Respond to customer inquiries and communicate with legal representatives, employers, claimants, and other stakeholders.
Follow Ohio Revised Code and BWC policies and procedures.
Why Work for the State of Ohio We provide a variety of quality, competitive benefits to eligible full‑time and part‑time employees. Benefits include:
Medical coverage
Free dental, vision, and basic life insurance premiums after the eligibility period
Paid time off (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)
Public retirement systems (OPERS, STRS, SERS, HPRS) and optional deferred compensation (Ohio Deferred Compensation)
Qualifications Experience:
36 months working in private insurance organization as claims representative or equivalent, or completing a typing course with 35 wpm, OR
Undergraduate core coursework in business, humanities, social & behavior science, education or related field with a typing course of 35 wpm, OR
24 months as Workers' Compensation Claims Assistant, 16720, OR as BWC Customer Service Representative, 64451, OR as BWC Employer Service Representative, 63521, OR
12 months as Workers' Compensation Medical Claims Specialist, 16721, OR
Any combination totaling at least 36 months of relevant experience.
Job Skills:
Claims Examination
Major Worker Characteristics Knowledge:
Workers' compensation laws, policies & procedures; eligibility criteria and processes; English grammar & spelling; oral & written business communication; public relations; math; interviewing techniques; internet search; medical terminology & coding; Industrial Commission processes; claims reserving.
Skills:
Operation of personal computer; typing; Microsoft Office; BWC-specific software (Claims Management System, Intrafin, FMS fraud system); office machinery; communication; internet.
Abilities:
Define problems, collect and analyze data, respond to inquiries, make referrals, diffuse volatile situations, present information, work with a team, use ICD coding, generate business correspondence, interpret reports.
Supplemental Information EEO & ADA Statement:
The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees based on 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 reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox eeodept@bwc.ohio.gov.
BWC OCSEA Selection Rights:
This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members.
Salary Information:
Hourly wage is expected to be paid at step 1 of the pay range for new state employees. Current employees will be placed at the appropriate step. Movement to the next step occurs after six months (roughly 4% increase) and annually thereafter. June adjustments may apply.
Educational Transcripts:
Unofficial transcripts detailing completed coursework must be attached.
Application Process:
All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.
Background Check:
Prior to an offer, the final applicant will sign a background check authorization form and undergo a criminal background check.
Drug-Free Workplace:
The State of Ohio is a drug-free workplace. This position may be subject to additional restrictions per the State of Ohio Drug-Free Workplace Policy (HR‑39).
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