Claims Examiner 3 - PN

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

Our mission is to serve injured workers and Ohio employers through expeditious and impartial resolution of issues arising from workers’ compensation claims and through the establishment of adjudication policy.

At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:

Medical Coverage

Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period

Paid time off, including vacation, personal, sick leave and 11 paid holidays per year

Childbirth, Adoption, and Foster Care leave

Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)

Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)

*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

This position is filled through an assessment consisting of a computer-based test and structured interview. The computer-based test will be administered in person at the William Green Building in Columbus, Ohio. The structured interview will be held in person in the Columbus Regional office.

This is an on-site position and in-office presence is required.

The hourly wage for this position is not negotiable. For applicants who are not current State of Ohio employees, the starting wage will be the hourly rate listed on this posting. Successful employees will move up a step in the salary range within one year, and in most cases within four to six months, with subsequent step increases occurring annually.

For internal applicants, the position will be filled pursuant to legislation or the provision of the OCSEA/AFSCME Contract.

ADA Statement\: The Industrial Commission is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs, and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws. To request a reasonable accommodation due to a disability please contact the ADA Coordinator, at (voice) or by email to\: as-soon-as possible but at least 14 days prior to the scheduled event.

Background Check Information Statement\: The final candidate selected for the position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.

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.

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.