Mansfield- WC Claims Specialists - (PN 20069686)

A Little About Us:

With roughly 1,600 employees in 11 offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home.
For Ohio employers, we provide insurance policies to cover workplace injuries, and we provide safety and wellness services to prevent injuries.

Our Culture:

BWC is a dynamic organization that offers career opportunities across many different disciplines. We value a skilled, diverse and engaged workforce. We’re committed to fostering and embracing an environment of inclusion and diversity to achieve our mission. Please click this link to read more, then come back to this job posting to submit your application!

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.

If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!

BWC is currently operating under a hybrid schedule that can incorporate both teleworking and in-office hours. Employees may be required to report to the office when requested by management &/or for their initial job training.

What You'll Be Doing:

• Manages a caseload of Workers’ Compensation claims: Communicates, coordinates & collaborates with internal & external stakeholders (e.g. Disability Management Coordinator [DMC], Medical Service Specialist [MSS], Managed Care Organization [MCO], Employer Management [EM] team, Safety & Hygiene, injured workers, employers, Third Party Administrators [TPA] & rehabilitation personnel) in order to set return to work expectations.
• Performs initial/subsequent claims investigation & determination within prescribed timeframes: Contacts parties involved in claim process; completes investigation during initial claim development to determine information pertinent to management of claim (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).
• Reviews claims & claim reserves for possible settlements & referrals; ensures data integrity associated with claim reserve elements; maintains the various Workers’ Compensation Claims Management Systems correct claims information including claim reserve data elements (e.g., employer & injured worker demographics, injured worker work history, benefit plans, progress notes, naming & housing of imaged documents, return to work history, accident information, diagnostic codes, MCO authorizations/denials);
• Responds to customer inquiries
• Follows Ohio Revised Code and BWC policies and procedures
• Attends various trainings and meetings throughout the year.
• Communicates with legal representatives, employers, claimants, etc.

What’s in it for you:

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

• Quality, affordable, and competitive medical benefits are offered through the available Ohio Med plans.

Dental, Vision and Basic Life Insurance

• Dental, vision, and basic life insurance premiums are free after completed eligibility period. Length of eligibility period is dependent on union representation.

Time Away From Work and Work/Life Balance

• Paid time off, including vacation, personal, and sick leave
• 11 paid holidays per year
• Childbirth/Adoption leave

Employee Development Funds

• The State of Ohio offers a variety of educational and professional development funding that varies based on whether you are a union-exempt employee or a union-represented employee.

Ohio Public Employees Retirement System

• OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.

Deferred Compensation

• The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.

Ohio is a Disability Inclusion State and strives to be a Model Employer of Individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

Required Experience and/or Education:

• Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute.
• Or 36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute.
• Or 24 mos. exp. 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 mos. exp. 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 mos. exp. 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 mos. exp. 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.

Necessary Skills and Competencies:

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 (e.g., Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., Workers’ Compensation Claims Management System, Intrafin, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., 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 about data, people, or things; respond to sensitive inquiries from & contacts with injured workers, employers, providers or their representatives, & the public; answer routine & technical inquiries from injured workers, employers, medical providers & public*; make proper referrals (within agency & external sources)*; diffuse potentially volatile situations; present information to others; work with a team; use International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.

(*) Developed after employment

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.

Salary Information:
Unless required by legislation or union contract, candidates will start at lowest rate of the salary range associated with this position.

Transportation:
Position may require travel; therefore, persons occupying this position must be able to provide own transportation &/or legally operate a state-owned vehicle.

Educational Transcripts:
For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.

Required 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.

EEO & ADA Statement:
The State of Ohio is an Equal Employment Opportunity Employer and does not discriminate based on race, color, religion, gender, gender identity or expression, national origin (ancestry), military status, disability, age (40 years or older), genetic information, sexual orientation, or caregiver status in making employment-related decisions about an individual.

The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its services, programs, and employment opportunities following the Americans with Disabilities Act and other applicable laws.