Cambridge - WC Claims Specialist - PN: 20068446
About The Position
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). Processes various types of compensation ranging from Temporary Total (TT) Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests; addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders & referrals to the Industrial Commission (IC) of Ohio Responds to customer inquiries Follows Ohio Revised Code and BWC policies and procedures Communicates with legal representatives, employers, claimants, etc.
Requirements
- 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.
- 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.
- 24 mos. exp. as Workers' Compensation Claims Assistant, 16720
- 24 mos. exp. as BWC Customer Service Representative, 64451
- 24 mos. exp. as BWC Employer Service Representative, 63521
- 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721
- 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.
Responsibilities
- Manages a caseload of Workers’ Compensation claims
- Communicates, coordinates & collaborates with internal & external stakeholders
- Performs initial/subsequent claims investigation & determination within prescribed timeframes
- Processes various types of compensation ranging from Temporary Total (TT) Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests
- Addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders & referrals to the Industrial Commission (IC) of Ohio
- Responds to customer inquiries
- Follows Ohio Revised Code and BWC policies and procedures
- Communicates with legal representatives, employers, claimants, etc.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
