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

State of Ohio • Cleveland, OH

4d • $27 - $35 • Onsite

About The Position

The Claims Specialist manages Workers’ Compensation claims and coordinates with internal and external stakeholders to establish return-to-work expectations. The role investigates claims, evaluates eligibility and claim information, makes allowance and compensation decisions, and supports customers in accordance with Ohio law and BWC policies and procedures.

The position is permanent and full-time, based at BWC’s Cleveland office. The stated work hours are 8:00 a.m. to 5:00 p.m.; BWC’s flex-time schedules may permit earlier or later start times subject to operational needs and supervisor approval. The position may require travel, and the employee must provide their own transportation and/or be legally able to operate a state-owned vehicle.

The position requires one of several experience or education-and-experience combinations related to evaluating medical or public assistance benefits, or specified experience in BWC and Workers’ Compensation roles. It is classified and represented by OCSEA. Selection follows the OCSEA Collective Bargaining Agreement, under which eligible BWC bargaining-unit members have selection rights before non-bargaining-unit members.

Requirements

• 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 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, BWC Customer Service Representative, and/or BWC Employer Service Representative.
• Alternatively, 12 months of experience as a Workers’ Compensation Medical Claims Specialist.
• 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, BWC Customer Service Representative, and/or BWC Employer Service Representative.
• Equivalent of the stated minimum class qualifications may be considered.
• Must be able to provide own transportation and/or legally operate a state-owned vehicle if required to travel.
• Final applicant must authorize and undergo a criminal background check before an employment offer.
• Applicants must submit an Ohio Civil Service Application through the online Ohio Hiring Management System; paper applications are not accepted.
• Educational achievements must be supported by at least an unofficial transcript detailing completed coursework to be considered during screening.

Responsibilities

• Manage a caseload of Workers’ Compensation claims and coordinate with internal and external stakeholders to establish return-to-work expectations.
• Conduct initial and subsequent claim investigations and determinations within prescribed timeframes; contact parties and gather information relevant to claim management, including jurisdiction, coverage, causality, compensability, claim-data accuracy, work status, job description, salary continuation, job demands, and work history.
• Process compensation requests, including Temporary Total compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, and Lump Sum Advancement.
• Address subsequent requests by parties through due-process notifications, investigation, BWC orders, and referrals to the Industrial Commission of Ohio.
• Evaluate information, issue orders, and make 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
• Free dental, vision, and basic life insurance premiums 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 Ohio Deferred Compensation

What This Job Offers

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