PN: 20068877 - Workers' Compensation Claims Specialist (Cincinnati)

State of Ohio • Springdale, OH

6d • Onsite

About The Position

The Workers' Compensation Claims Specialist manages a caseload of workers’ compensation claims and works with internal and external stakeholders to establish return-to-work expectations. The position performs initial and subsequent claims investigations and determinations within prescribed timeframes, contacting relevant parties and gathering information about jurisdiction, coverage, causality, compensability, claim accuracy, claimant work status, job duties and physical demands, salary continuation, and work history.

The specialist processes compensation requests including Temporary Total, Wage Loss, Permanent Partial, Percentage of Permanent Partial, Living Maintenance, and Lump Sum Advancement. The role also addresses subsequent requests through due-process notifications, investigations, BWC orders, and referrals to the Industrial Commission of Ohio. The specialist responds to customer inquiries, communicates with legal representatives, employers, claimants, and others, and follows the Ohio Revised Code and BWC policies and procedures.

The position is based at the BWC office at 135 Merchant St, Suite 100, Springdale, Ohio. BWC’s core operating hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.; daily start and end times may vary based on operational needs, and flex-time schedules may be available with supervisor approval. The position may require travel, and the employee must provide transportation and/or be legally able to 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 payments, or perform similar duties; or an alternative qualification listed in the posting.
• Alternative qualification: completion of undergraduate core coursework in business, humanities, social and behavioral science, education, or a related field, plus 12 months of qualifying benefits-evaluation experience.
• Alternative qualification: 24 months of experience as a Workers' Compensation Claims Assistant, BWC Customer Service Representative, and/or BWC Employer Service Representative.
• Alternative qualification: 12 months of experience as a Workers' Compensation Medical Claims Specialist.
• Equivalent combinations of the listed qualifying experience may satisfy the minimum qualifications.
• Knowledge of workers' compensation laws, policies and procedures; eligibility criteria and claims-processing procedures; business communication; public relations; arithmetic; interviewing techniques; internet navigation; medical terminology and diagnosis coding; Industrial Commission processes; and claims reserving.
• Skill in personal computer and typing operation; Microsoft Office; BWC-specific software; office machinery; communication; and internet use.
• Ability to investigate problems, collect and classify information, draw conclusions, understand medical references and reports, respond to inquiries and sensitive contacts, make referrals, diffuse potentially volatile situations, present information, work with a team, use ICD coding resources, prepare business correspondence, and interpret compensation payment plan screens and Cognos reports.
• Must provide own transportation and/or be legally able to operate a state-owned vehicle if travel is required.
• Final applicant must authorize and undergo a criminal background check prior to an offer of employment.
• Applicants must submit an Ohio Civil Service Application through the online Ohio Hiring Management System; paper applications are not accepted.
• An unofficial transcript detailing completed coursework must be attached for educational achievements to be considered during screening.

Responsibilities

• Manage a caseload of workers’ compensation claims.
• Coordinate and collaborate with internal and external stakeholders to set return-to-work expectations.
• Conduct initial and subsequent claims investigations and determinations within prescribed timeframes.
• Contact parties involved in the claim process and gather information relevant to claim management, including jurisdiction, coverage, causality, compensability, claimant work status, job description, salary continuation, job physical demands, and work history.
• Process requests for Temporary Total, Wage Loss, Permanent Partial, Percentage of Permanent Partial, Living Maintenance, and Lump Sum Advancement compensation.
• Address subsequent claim requests through due-process notifications, investigations, BWC orders, and referrals to the Industrial Commission of Ohio.
• 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 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
• Optional deferred compensation through Ohio Deferred Compensation

What This Job Offers

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