WC Claims Specialists (20068659 & 20068710)

State of Ohio • Columbus, OH

14h • $27 - $35 • Onsite

About The Position

The WC Claims Specialist manages workers’ compensation claims for the Ohio Bureau of Workers’ Compensation. The role investigates and determines claims within required timeframes, evaluates information under workers’ compensation law and policy, makes claim allowance decisions, and processes compensation. The specialist works with internal and external stakeholders to establish return-to-work expectations and develop and implement customer care plans for eligible claims. The position also responds to customer inquiries and follows the Ohio Revised Code and BWC policies and procedures.

This is a permanent, full-time classified position in the Workers’ Compensation organization, based at 30 West Spring Street in Columbus, Ohio. The listed work hours are 8:00 a.m. to 5:00 p.m.; BWC’s core operating hours are Monday through Friday, and flex-time schedules may be available subject to operational need and supervisor approval. The position may require travel, and the employee must be able to provide transportation and/or legally operate a state-owned vehicle.

Requirements

• At least 36 months of experience 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 an accepted alternative qualification pathway.
• Alternative pathway: completion of undergraduate core coursework in business, humanities, social and behavioral science, education, or a related field, plus at least 12 months of qualifying benefits-evaluation experience.
• Alternative pathway: 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).
• Alternative pathway: at least 12 months of experience as a Workers’ Compensation Medical Claims Specialist (16721).
• Alternative pathway: a combination totaling at least 36 months of qualifying benefits-evaluation experience and/or experience in the listed Workers’ Compensation Claims Assistant, BWC Customer Service Representative, or BWC Employer Service Representative roles.
• Equivalent of the stated minimum class qualifications may be accepted.
• Must be able to provide own transportation and/or legally operate a state-owned vehicle if travel is required.
• Applicants must submit an Ohio Civil Service Application through the online Ohio Hiring Management System; paper applications will not be accepted.
• A final applicant must sign a background check authorization form and undergo a criminal background check before an offer of employment.

Responsibilities

• Manage a caseload of workers’ compensation claims and coordinate with internal and external stakeholders to set return-to-work expectations.
• Conduct initial and subsequent claim investigations and determinations within prescribed timeframes, contacting involved parties and gathering information relevant to claim management.
• Investigate 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 compensation, Percentage of Permanent Partial compensation, Living Maintenance, and Lump Sum Advancement.
• Address subsequent requests from parties through due process notifications, investigations, BWC orders, and referrals to the Industrial Commission of Ohio.
• Evaluate information and issue orders and claim allowance decisions under 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 involved parties.
• Follow the Ohio Revised Code and BWC policies and procedures.

Benefits

• Medical coverage.
• Dental, vision, and basic life insurance premiums covered after the eligibility period.
• Paid time off, including vacation, personal and 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 Ohio Deferred Compensation.

What This Job Offers

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