WC Claims Specialists (20069627)

State of Ohio • Toledo, OH

14h • $27 - $35 • Onsite

About The Position

The WC Claims Specialist manages a caseload of workers’ compensation claims and coordinates with internal and external stakeholders to establish return-to-work expectations. The position investigates and determines claims within required timeframes, evaluates information, makes claim allowance decisions under workers’ compensation laws and policies, and processes compensation requests. It also responds to customer inquiries and communicates with claimants, employers, legal representatives, and other parties. The role follows the Ohio Revised Code and BWC policies and procedures.

The position is permanent and full-time, based at the Toledo office. Core BWC operating hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.; flex-time schedules may be available subject to operational needs and supervisor approval. The position may require travel, and the employee must provide their own transportation and/or be able to legally operate a state-owned vehicle.

Requirements

• At least 36 months of experience in a position evaluating medical or public assistance benefits to determine eligibility, approve or deny claims, resolve benefit-related disputes, calculate benefit payments, or perform similar benefit-related duties; or the specified equivalent qualifications below.
• Alternatively, completion of undergraduate core coursework in business, humanities, social and behavioral science, education, or a related field, plus at least 12 months of experience evaluating medical or public assistance benefits in the specified manner.
• Alternatively, at least 24 months of experience as a Workers' Compensation Claims Assistant (16720), BWC Customer Service Representative (64451), and/or BWC Employer Service Representative (63521).
• Alternatively, at least 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 of the stated minimum class qualifications.
• Applicants must submit an Ohio Civil Service Application through the online Ohio Hiring Management System; paper applications are not accepted.
• To have educational achievements considered during screening, applicants must attach at least an unofficial transcript detailing completed coursework.
• The final applicant must authorize and undergo a criminal background check before an offer of employment.
• Must be able to provide their 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 claims investigations and determinations within prescribed timeframes.
• Contact parties involved in the claims process and gather 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, Living Maintenance, and Lump Sum Advancement.
• Address subsequent requests from parties through due-process notification, 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.
• Communicate with legal representatives, employers, claimants, and other parties.
• Follow the Ohio Revised Code and BWC policies and procedures.

Benefits

• Medical coverage.
• Free dental, vision, and basic life insurance premiums after completion of the eligibility period.
• Paid time off, including vacation, personal leave, sick leave, and 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, and optional deferred compensation through Ohio Deferred Compensation.
• Possible cost-of-living adjustments and longevity supplements beginning after five years of state service.

What This Job Offers

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