MCO Statistical Payment Program Manager (TMS)

MCO Statistical Payment Program Manager

Organization: Workers' Compensation Agency Contact Name and Information:

Unposting Date: Sep 6, 2025, 3:59:00 AM

Work Location: William Green Building, 30 West Spring Street, Columbus, 43215-2256

Primary Location: United States of America-OHIO-Franklin County-Columbus

Compensation: $39.22/hr.

Schedule: Full-time

Work Hours: 8:00 am - 5:00 pm

Classified Indicator: Classified

Union: Exempt from Union

Primary Job Skill: Health Administration

Technical Skills: Health Administration, Nursing, Statistics/Mathematics

Professional Skills: Attention to Detail, Critical Thinking, Developing Others

A Little About Us: With roughly 1,500 employees in 7 offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers. For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.

Our Culture: BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC employees strive to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee resource groups, participate in online forums discussing society's impact on our services and workplace, and learn about how different perspectives can improve leadership skills.

Our Vision: To transform BWC into an agile organization driven by customer success.

Our Mission: To deliver consistently excellent experiences for each BWC customer every day.

Our Core Values: One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.

What our employees have to say: BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include: BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work. I have worked at several state agencies and BWC is the best place to work. Best place to work in the state and with a sense of family and support. I love the work culture, helpfulness, and acceptance I've been embraced with at BWC. I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.

Job Description

What You'll Be Doing: Under the direction of the Director of the MCO Business Unit, the MCO Statistical Payment Program Manager will lead the management, statistical analyses, and processing of the contract payment to BWC's 9 Managed Care Organizations. This role includes compiling, reviewing, and stratifying large amounts of data used in the calculation of the payment, and managing contract payment appeals. The payment manager will work with the team to develop statistical cost and outcome predictions used to negotiate contract terms and measure program outcomes. The payment manager will develop payment policies and operational controls for efficient and accurate payment methodologies.

The ideal candidate will be familiar with use of Microsoft Excel, and statistical modeling tools. The candidate should also possess an ability to work both independently and to facilitate project teams and demonstrate a high level of critical thinking and analytical skills.

Qualifications

To Qualify, You Must Clearly Demonstrate: Required Experience and/or Education: Completion of graduate core program in health care administration AND 12 months experience in medical policy development for medical provider or insurance company. Or completion of undergraduate program core coursework in pre-medicine, allied medical field, nursing or related field of study AND 12 months practical experience in health care field AND 12 months experience in writing medical policies & procedures for medical provider or insurance company AND 12 months practical experience in health care field.

Preferred Qualifications: Master's degree in health administration, public administration, business administration, mathematics or statistics.

*** THE 12 MONTHS EXPERIENCE WRITING MEDICAL POLICIES & PROCEDURES IS REQUIRED FOR EACH SECTION FOR THE ABOVE MINIMUM QUALIFCATIONS. YOU MUST HAVE THIS IN ADDITION TO THE OTHER MINIMUM QUALIFICATIONS IN THE SECTION ***

Major Work Characteristics: Knowledge of medical/rehabilitation services; health care coverage & reimbursement techniques; health care administration; cost containment measures; statistical analysis; workers' compensation medical policies & insurance industry standards*; supervisory principles/techniques*. Skill in operation of personal computer*. Ability to understand somewhat abstract field of study (i.e., health care); write & edit technical manuals & instructions; create complex reports using computer software; gather, collate & classify information about data, people or things. Developed after employment.