(7) Canton- Claims Specialists (20068383, 20068366, 20068404, 20068996,20069012, 20069887, 20069675)

State of Ohio•North Canton, OH

10d•Onsite

About The Position

The Ohio Bureau of Workers' Compensation (BWC) is hiring Claims Specialists to manage workers’ compensation claims and deliver customer service to injured workers, employers, and other stakeholders. The role investigates and determines claims within prescribed timeframes, evaluates information under workers’ compensation law and policy, makes claim-allowance decisions, and processes different types of compensation. It also involves coordinating return-to-work expectations and developing customer care plans with managed care organizations. The position is permanent and full-time, based at 339 E. Maple St., Suite 200, North Canton, Ohio. BWC’s core hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.; daily start and end times may vary with operational needs. Flex-time schedules may allow a start between 7:00 a.m. and 8:30 a.m., subject to operational needs and supervisor approval. The position may require travel, and employees must be able to provide their own transportation and/or legally operate a state-owned vehicle.

Requirements

36 months of experience in a position requiring evaluation of medical or public assistance benefits to determine eligibility, approve or deny claims, resolve benefit-related disputes, calculate benefit payments, or perform similar duties; OR completion of undergraduate core coursework in business, humanities, social and behavioral science, education, or a related field, plus 12 months of such experience.
Alternatively, 24 months of experience as a Workers’ Compensation Claims Assistant (16720), BWC Customer Service Representative (64451), and/or BWC Employer Service Representative (63521).
Alternatively, 12 months of experience as a Workers’ Compensation Medical Claims Specialist (16721).
Alternatively, a combination of at least 36 months of experience evaluating medical or public assistance benefits and/or working as a Workers’ Compensation Claims Assistant (16720), BWC Customer Service Representative (64451), and/or BWC Employer Service Representative (63521), or an equivalent combination meeting the minimum class qualifications.
Applicants must submit an Ohio Civil Service Application through the online Ohio Hiring Management System; paper applications are not accepted.
Applicants must attach at least an unofficial transcript documenting completed coursework for educational achievements to be considered during screening.
The final applicant must sign a background-check authorization form and undergo a criminal background check before receiving an offer.
Must be able to provide own transportation and/or legally operate a state-owned vehicle if travel is required.

Responsibilities

Manage a caseload of workers’ compensation claims.
Communicate, coordinate, and collaborate with internal and external stakeholders to establish return-to-work expectations.
Conduct initial and subsequent claim investigations and determinations within prescribed timeframes.
Contact parties involved in the claim process and investigate information relevant to claim management, including jurisdiction, coverage, causality, compensability, claim-data accuracy, claimant work status, job description, salary continuation, job physical demands, and claimant work history.
Process temporary total compensation, wage loss, permanent partial and percentage of permanent partial compensation, living maintenance, and lump-sum advancement requests.
Address subsequent requests by claim parties through due-process notifications, investigation, BWC orders, and referrals to the Industrial Commission of Ohio.
Evaluate information and issue orders and claim-allowance decisions in accordance with workers’ compensation law and policy.
Develop and implement customer care plans for eligible claims in collaboration with managed care organizations, including return-to-work planning.
Respond to customer inquiries.
Follow the Ohio Revised Code and BWC policies and procedures.
Communicate with legal representatives, employers, claimants, and other parties.

Benefits

Medical coverage
Dental insurance premiums covered after completion of the eligibility period
Vision insurance premiums covered after completion of the eligibility period
Basic life insurance premiums covered after completion of the eligibility period
Paid vacation, personal, and sick leave
11 paid holidays per year
Childbirth, adoption, and foster care leave
Education and development opportunities, including employee development funds and Public Service Loan Forgiveness
Public retirement systems, including OPERS, STRS, SERS, and HPRS
Optional deferred compensation through Ohio Deferred Compensation
Possible cost-of-living adjustments and longevity supplements beginning after five years of state service