Ohio Jobs
Cincinnati - BWC Fraud Analyst (Research Fraud Analyst) - PN: 20066719
Ohio Jobs, Cincinnati, Ohio, United States, 45202
BWC Fraud Analyst (Research Fraud Analyst)
Organization: Workers' Compensation Agency Contact Name and Information: Matthew Palte- HCM Sr. Analyst: Matthew.P.2@bwc.ohio.gov Work Location: Cincinnati Claims Office, 135 Merchant Street, Springdale, 45246 Primary Location: United States of America-OHIO-Hamilton County-Springdale Compensation: $33.52 - $49.18 Schedule: Full-time Work Hours: 40 Classified Indicator: Classified Union: OCSEA Primary Job Skill: Investigation Technical Skills: Investigation Professional Skills: Analyzation, Critical Thinking, Ethics and Values, Teamwork, Written Communication A Little About Us: 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. Our Culture: BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about 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. Job Description
BWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval. What Our Employees Have to Say: BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include: BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work. I have worked at several state agencies and BWC is the best place to work. Best place to work in the state and with a sense of family and support. I love the work culture, helpfulness, and acceptance I've been embraced with at BWC. I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC. What You'll Be Doing: Works under direction of Special Investigations Supervisors & primarily conducts internal & external record searches and/or review and cross reference of data to identify red flags for further investigation; collaborates with the BWC Intelligence Unit to develop new data sets to analyze, collate, and mine for data anomalies and trends for further investigation; generates allegations and investigative leads for the BWC special Investigation teams by utilizing the Fraud Management System (FMS), CORESuite, Internet, IBM Cognos, Tableau, Microsoft Excel as well as develop data from external sources, Criminal Justice data bases & other systems to effectively facilitate detection & investigation support; acts as a lead worker establishing criteria to detect fraudulent activity & initiate investigations into allegations of fraud, abuse, & assist with development of detection ideas; identifies behavioral trends &/or performs outlier analyses for stratified data populations; using computer technologies & advanced analysis techniques to design databases, compile & analyze large data sets in order to assist team in investigations of fraudulent schemes. Why Work for the State of Ohio: 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
54 mos. exp. in private insurance organization as claims representative, criminal investigator, rehabilitation case manager or equivalent position; 6 mos. exp. in operation of personal computer; valid driver's license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment. -Or completion of undergraduate core coursework in business, criminal justice, humanities, social & behavioral science, education or related field; 18 mos. exp. in insurance organization as claims representative, criminal investigator, rehabilitation case manager or equivalent position; 6 mos. exp. in operation of personal computer; valid driver's license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment. -Or 18 mos. exp. as Workers' Compensation Claims Specialist, 16722, or managing caseload of workers' compensation lost-time disability claims which involved making decision to allow or deny claim, verifying appropriateness of medical treatment & charges, pre-authorized medical treatment, equipment, supplies & special travel arrangements, researching, negotiating, authorizing & issuing settlement of claims &/or conducting field inquiries to accurately assess claim information & resolving disputed condensability & benefit level for Ohio Bureau Of Workers' Compensation; 6 mos. exp. in operation of personal computer; valid driver's license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment. -Or 18 mos. exp. as BWC Fraud Investigator, 26261. 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 Adjudication & Maintenance of Workers' Compensation Claims*& policies; Agency, State &/or Federal Statutes, rules, regulations & procedures applicable to investigation, evidence gathering & search & seizure*; English; oral & written communication; Public relations; interviewing techniques; principles of customer service; fundamental math operations; standard business practices. Skill in use of personal computer; word processor*; data base & spreadsheet software*; analytical software used in Fraud Detection*; surveillance equipment (e.g., digital camera, video camera, mini camera; undercover audio recording devices)* Ability to communicate effectively & professionally with injured workers, employers, legislators, health care providers & public; make complex decisions regarding claims & policy activity; read & understand medical policy reference manuals; write clear, concise & professional correspondence & reports; collate & classify information about data, people or things; assess immediate situation & make split second decisions; respond to sensitive inquiries from & contacts with injured workers, employers, legislators, health care providers & public. 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 ADA Coordinator Kathleen Bourke at 614-644-7811 or by email to: eeodept@bwc.state.oh.us. 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. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.
Organization: Workers' Compensation Agency Contact Name and Information: Matthew Palte- HCM Sr. Analyst: Matthew.P.2@bwc.ohio.gov Work Location: Cincinnati Claims Office, 135 Merchant Street, Springdale, 45246 Primary Location: United States of America-OHIO-Hamilton County-Springdale Compensation: $33.52 - $49.18 Schedule: Full-time Work Hours: 40 Classified Indicator: Classified Union: OCSEA Primary Job Skill: Investigation Technical Skills: Investigation Professional Skills: Analyzation, Critical Thinking, Ethics and Values, Teamwork, Written Communication A Little About Us: 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. Our Culture: BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about 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. Job Description
BWC's core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC's seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval. What Our Employees Have to Say: BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include: BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work. I have worked at several state agencies and BWC is the best place to work. Best place to work in the state and with a sense of family and support. I love the work culture, helpfulness, and acceptance I've been embraced with at BWC. I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC. What You'll Be Doing: Works under direction of Special Investigations Supervisors & primarily conducts internal & external record searches and/or review and cross reference of data to identify red flags for further investigation; collaborates with the BWC Intelligence Unit to develop new data sets to analyze, collate, and mine for data anomalies and trends for further investigation; generates allegations and investigative leads for the BWC special Investigation teams by utilizing the Fraud Management System (FMS), CORESuite, Internet, IBM Cognos, Tableau, Microsoft Excel as well as develop data from external sources, Criminal Justice data bases & other systems to effectively facilitate detection & investigation support; acts as a lead worker establishing criteria to detect fraudulent activity & initiate investigations into allegations of fraud, abuse, & assist with development of detection ideas; identifies behavioral trends &/or performs outlier analyses for stratified data populations; using computer technologies & advanced analysis techniques to design databases, compile & analyze large data sets in order to assist team in investigations of fraudulent schemes. Why Work for the State of Ohio: 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
54 mos. exp. in private insurance organization as claims representative, criminal investigator, rehabilitation case manager or equivalent position; 6 mos. exp. in operation of personal computer; valid driver's license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment. -Or completion of undergraduate core coursework in business, criminal justice, humanities, social & behavioral science, education or related field; 18 mos. exp. in insurance organization as claims representative, criminal investigator, rehabilitation case manager or equivalent position; 6 mos. exp. in operation of personal computer; valid driver's license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment. -Or 18 mos. exp. as Workers' Compensation Claims Specialist, 16722, or managing caseload of workers' compensation lost-time disability claims which involved making decision to allow or deny claim, verifying appropriateness of medical treatment & charges, pre-authorized medical treatment, equipment, supplies & special travel arrangements, researching, negotiating, authorizing & issuing settlement of claims &/or conducting field inquiries to accurately assess claim information & resolving disputed condensability & benefit level for Ohio Bureau Of Workers' Compensation; 6 mos. exp. in operation of personal computer; valid driver's license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment. -Or 18 mos. exp. as BWC Fraud Investigator, 26261. 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 Adjudication & Maintenance of Workers' Compensation Claims*& policies; Agency, State &/or Federal Statutes, rules, regulations & procedures applicable to investigation, evidence gathering & search & seizure*; English; oral & written communication; Public relations; interviewing techniques; principles of customer service; fundamental math operations; standard business practices. Skill in use of personal computer; word processor*; data base & spreadsheet software*; analytical software used in Fraud Detection*; surveillance equipment (e.g., digital camera, video camera, mini camera; undercover audio recording devices)* Ability to communicate effectively & professionally with injured workers, employers, legislators, health care providers & public; make complex decisions regarding claims & policy activity; read & understand medical policy reference manuals; write clear, concise & professional correspondence & reports; collate & classify information about data, people or things; assess immediate situation & make split second decisions; respond to sensitive inquiries from & contacts with injured workers, employers, legislators, health care providers & public. 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 ADA Coordinator Kathleen Bourke at 614-644-7811 or by email to: eeodept@bwc.state.oh.us. 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. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.