Columbus- Claims Specialist - PN

Job Description

Columbus – Claims Specialist – PN: ,  (2600002Z)

The Ohio Bureau of Workers' Compensation Human Resources invites applicants to support Ohio workers by managing workers' compensation claims, ensuring quality medical and pharmacy care, and promoting safety at work and home.

• Manage a caseload of workers’ compensation claims, communicating and coordinating with internal and external stakeholders (e.g., Disability Management Coordinator, Medical Service Specialist, Managed Care Organization, Employer Management team, Safety & Hygiene, injured workers, employers, Third Party Administrators & rehabilitation personnel) to set return-to-work expectations.
• Perform initial and subsequent claims investigation and determination within prescribed time frames, contacting parties involved in the claim process and completing investigation to gather information pertinent to claims management (e.g., jurisdiction, coverage, causality, compensability, claim data accuracy, current work status of claimant, job description, salary continuation, physical demands of job, & work history of claimant).
• Process various types of compensation, including Temporary Total Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, and Lump Sum Advancement requests; address subsequent requests by parties to claim through due process notification, investigation, BWC orders & referrals to the Industrial Commission of Ohio.
• Evaluate information and issue orders, make claim allowance decisions in regard to workers' compensation law and/or policy, develop and implement customer care plan for all eligible claims through collaboration with MCOs (e.g., Return to Work).
• Respond to customer inquiries and follow Ohio Revised Code and BWC policies and procedures.
• Communicate with legal representatives, employers, claimants, and others.

We provide a variety of quality, competitive benefits to eligible full-time and part-time employees. For a full list of benefits, visit the Total Rewards website.

• 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 System membership (OPERS, STRS, SERS, HPRS) and optional deferred compensation (Ohio Deferred Compensation)

• 36 months experience working in private insurance organization as claims representative or equivalent; successful completion of one typing course or ability to type 35 words per minute.
• Or completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of one typing course or ability to type 35 words per minute.
• Or 24 months experience as Workers' Compensation Claims Assistant, 16720.
• Or 24 months experience as BWC Customer Service Representative, 64451, or as BWC Employer Service Representative, 63521.
• Or 12 months experience as Workers' Compensation Medical Claims Specialist, 16721.
• Or any combination of at least 36 months experience working in private insurance organization as claims representative or equivalent and/or as Workers' Compensation Claims Assistant, 16720 and/or as Workers' Customer Service Representative, 64451 and/or as Workers’ Compensation Employer Service Representative, 63521.
• Or equivalent of Minimum Class Qualifications for Employment noted above (job skills: Claims Examination).

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;…