Claims Examiner 3 - PN

Schedule: Full-time

The Ohio Industrial Commission is seeking an experience claims examiner with a customer focused background who can handle assigned claims following agency guidelines and procedures, someone who can adapt to change and remain professional while working with OIC customers.

The selected individual must have strong customer service skills, must pay attention to details when reviewing claims and produce accurate work product and have the ability to multi-task, prioritize and manage time effectively.

Under general supervision, reviews exam reports for medical sufficiency using personal computer applications (CAS, ECM, Case Manager, SharePoint, ICON, BWC applications):data retrieval, verification, resolution, tracking & organization.

Reviews issues according to established Workers’ Compensation laws and Industrial Commission rules, policies and procedures

Communicates with OIC specialist and office staff

Reviews/analyzes claim documents and images to determine pertinent data (statements of facts, claims allowances, medical evidence, disability factors, specialist exam type, etc.)

Re-indexes and proofreads documents to ensure an accurate specialist packet and hearing folder

Creates medical examination work sheets and/or electronic folders

Determines number of exam(s) needed and specialty type(s)

Creates medical examination work sheets and/or electronic folders

Determines number of exams needed and specialty

Captures issues, tracks PCNs and updates claim/exam information (addresses, risk and representative changes, allowances/disallowances, etc.) in CAS

Reconciles delayed medical reports

Processes incoming mail and faxes

Determines whether supporting medical evidence is sufficient & refers for dismissal if lacking

Reviews & documents information necessary to compose & write or type statement of facts

Prepares 1st and 2nd level claims issues for hearing and hearing officer review

See the attached position description for more details regarding this position.

Formal education in arithmetic that includes addition, subtraction, multiplication, division, fractions, decimals & percentages & in reading, writing & speaking common English vocabulary; 6 mos. trg. or 6 mos. exp. in examining claims, eligibility criteria, departmental policies & procedures & applicable laws required to process workers' compensation claims; 3 mos. trg. or 3 mos. exp. in medical terminology.

-Or 6 mos. exp. as Claims Examiner 2, 16792.

-Or equivalent of Minimum Class Qualifications for Employment noted above.

Job Skills: Claims Examination

Technical Skills: Customer Service, Medical Terminology,

Professional Skills: Attention to Detail, Proofreading, Time Management, Written Communication