(2) Cleveland- Claims Specialist (20068990, 20069001)

State of Ohio • Cleveland, OH

3d • Onsite

About The Position

The Ohio Bureau of Workers' Compensation (BWC) is hiring a Claims Specialist to manage workers' compensation claims and help injured workers, employers, and other stakeholders navigate claim decisions and return-to-work planning. The role involves investigating claims, determining eligibility and compensability, evaluating information under workers' compensation law and BWC policy, processing compensation requests, and responding to customer inquiries. The position is based at BWC's Cleveland office and may require travel.

Requirements

• One of the following experience or education combinations: 36 months of experience evaluating medical or public-assistance benefits to determine eligibility, approve or deny claims, resolve benefit-related disputes, calculate payments, or perform similar duties; or 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, BWC Customer Service Representative, or BWC Employer Service Representative; or 12 months as a Workers' Compensation Medical Claims Specialist.
• A qualifying combination of at least 36 months of experience evaluating medical or public-assistance benefits and/or working in the listed BWC roles may also meet the minimum qualifications, as may an equivalent combination.
• Ability to provide personal transportation and/or legally operate a state-owned vehicle if required for travel.

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 claims investigations and determinations within prescribed timeframes.
• Contact parties involved in claims 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 requests for Temporary Total Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial compensation, Living Maintenance, and Lump Sum Advancement.
• Address subsequent claim requests 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, vision, and basic life insurance premiums at no cost after the eligibility period
• Paid vacation, personal, and sick leave, plus 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed