Claims Specialist Jobs

About The Position

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 duties; or an equivalent combination of qualifying experience.
• Alternatively, 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.
• Alternatively, at least 24 months of experience as a Workers’ Compensation Claims Assistant, BWC Customer Service Representative, and/or BWC Employer Service Representative.
• Alternatively, at least 12 months of experience as a Workers’ Compensation Medical Claims Specialist.
• 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 are not accepted.
• A final applicant must authorize 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 claims investigations and determinations within prescribed timeframes.
• Contact parties involved in the claims process and gather information about jurisdiction, coverage, causality, compensability, claim data accuracy, claimant work status and history, job duties, physical demands, and salary continuation.
• 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 through due-process notification, investigation, BWC orders, and referrals to the Industrial Commission of Ohio.
• Evaluate information, issue orders, and make 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 and 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 the eligibility period
• Paid vacation, personal, and sick leave, plus 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 and optional deferred compensation