WC Medical Claims Specialist -PN: 20068788 & 20068759

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.

• 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.

If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!

• Performs initial/subsequent claims investigation and determinations for Medical-Only claims within prescribed time frames.
• Reviews and gathers information necessary to identify the claim severity. Will staff more complex claims with supervisor, team nurses, and field service office staff.
• Through phone contacts, written correspondence, and investigation, makes initial and subsequent claim determinations and issues orders as appropriate.
• Sends Due Process notifications; reviews claim for supporting medical; refers claim for medical review if necessary and issues appropriate BWC orders.
• Create Case for referral to the Industrial Commission of Ohio for a decision as needed.
• Processes and maintains claim information, medical and legal documents within prescribed time frames, and records information in system.
• Updates tasks list. Responds orally and in writing to requests from injured workers, employers, providers, legal representatives, managed care organizations, and legislators.
• Documents claim transactions and activities in claim management system notes and establishes claim tasks for ongoing claim management.

3 courses or 9 mos. trg. or 9 mos. exp. in English composition or grammar; 3 courses or 9 mos. trg. or 9 mos. exp. in accounting, bookkeeping or general business mathematics; 3 courses or 9 mos. trg. or 9 mos. exp. in communication or public speaking or 9 mos. exp. involving contact with injured workers, employers, legislators, providers or their representatives & public;

successful completion of one typing course or demonstrate ability to type 35 words per minute.

• Or 12 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 12 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).
  
  Note:
  
  Classifications may require use of proficiency demonstration to determine minimum class qualifications for employment.
• Or equivalent of Minimum Class Qualifications For Employment noted above.

Claims Examination

workers' compensation laws,…