(4) Workers' Compensation Claims Specialists (PN

Schedule: Full-time

BWC’s core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC’s seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.

What You’ll Be Doing:

Manages a caseload of Workers' Compensation claims: Communicates, coordinates and collaborates with internal and external stakeholders in order to set return to work expectations.

Performs initial/subsequent claims investigation and determination with prescribed timeframes: Contacts parties involved in claim process and completes investigation during initial claim development to determine information pertinent to management of claim.

Process various types of compensation ranging from Temporary Total Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests, Survivor Benefits; addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders and referrals to the Industrial Commission of Ohio.

Evaluates information and issues orders, makes claim allowance decisions in regard to Workers' Compensation law and/or policy develops, implements, customer care plan on all eligible claims through collaboration with Managed Care Organizations; processes various types of compensation.

Responds to customer inquiries.

Follows Ohio Revised Code and BWC policies and procedures.

Communicates with legal representatives, employers, claimants, etc.

To Qualify, You Must Clearly Demonstrate:

36 mos. exp. working in private insurance organization as claims representative or equivalent position AND successful completion of one typing course or demonstrate ability to type 35 words per minute.

-Or Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field AND successful completion of one typing course or demonstrate ability to type 35 words per minute.

-Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self- insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information, & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law).

-Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations) &/or as BWC Employer Service Representative, 63521, (i.e., providing information & assistance &/or responding to complaints, questions & inquiries from customers regarding workers’ compensation coverage, established binder/applications maintenance, demographics, supplemental & legal entities, manual classifications, debits/credits & payroll reports &/or various BWC programs & research & explain employer refunds, attorney general balances, payments made to policies &/or divided credits).

-Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers' Compensation).

-Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &/or as Workers' Compensation Claims Assistant, 16720 &/or as Workers' Customer Service Representative, 64451 &/or as Workers’ Compensation Employer Service Representative, 63521.

-Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment.

Job Skills: Claims Examination

Major Worker Characteristics:

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*. Developed after employment

**THIS CLASSIFICATION MAY REQUIRE THE USE OF PROFICIENCY DEMONSTRATION TO DETERMINE MINIMUM QUALIFICATIONS**