These positions shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for the given positions(s).
There are 2 positions available. Only 1 application is required to be given consideration for both.
Under direction, performs claims management functions including: A) Performs initial/subsequent claims investigation & determination within prescribed timeframes: Through phone contacts with parties involved in the claim, completes investigation during initial claim development to determine information pertinent to management of claim (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); obtains necessary claim information via telephone or through request of witness statements; establishes & maintains contact with all interested parties (e.g., injured worker, employers, legislators, health care providers, attorney/representatives, & MCO’s) upon claim assignments. Through review for subrogation issues refers to subrogation unit when appropriate; determines if claim is complex (e.g., catastrophic, amputations, death claims); reviews for potential proactive allowances; identifies & refers cases of potential fraud to Special Investigations unit. By weighing evidence collected through phone contacts & investigation, makes claim allowance decisions based on the evidence within the intent of the law &/or BWC policy; develops, & takes action to implement, customer care plan on all allowed claims. Issues orders by making initial & subsequent decisions based on the evidence in the claim, Ohio Workers’ Compensation law &/or policy; processes Lump Sum Advancement requests; addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders & referrals to the Industrial Commission of Ohio. B) By review of claims & MIRA reserves for possible settlements & referrals ensures data integrity associated with Micro Insurance Reserve Analysis (MIRA) elements; updates & maintains the various claims management systems with the correct claims information including MIRA data elements (e.g., employer & injured worker demographics, injured worker work history, benefit plans, progress notes, naming & housing of imaged documents, return to work history, accident information, diagnostic codes, MCO authorizations/denials); reviews & verifies manual classifications for the claim in question. C) Processes medical & legal documents within prescribed timeframes: Reviews medical documentation (e.g., operative reports, diagnostic testing, office visits) & legal documentation (e.g., IC orders, motions) & takes appropriate action. Receives medical & legal documentation & re-indexes into claim file under descriptive name; images documentation into claim file if necessary. Completes application processing & updates V3 application tracker throughout process. Processes applications by utilizing appropriate V3 diaries. Updates & maintains V3 worklist. D) Performs special assignments related to claims processing: Performs Lump Sum Settlement (LSS) activities including evaluation of claims cost & liabilities (e.g., Reserves/Max Values, Justifications, indemnity, medical); notifies MCO of pending settlements; prepares, evaluates & negotiates settlements up to $10,000; prepares & evaluates settlements over $10,000 & presents to supervising attorney or designee for approval; upon agreement of all parties issues settlement approval; build LSS plan to pay award. Acts as V3 Coordinator in handling of difficult issues on V3 payment system; assists other claims specialists with problematic or difficult V3 compensation plans; coordinates office issues with V3 Customer Support Team. Acts as Death Benefits Coordinator in handling the input & maintenance of dependant information on V3; builds & maintains death benefit plans. Acts as PTD Benefits Coordinator in ensuring compensation rates are correct; ensures DWRF unit has made necessary adjustments on PTD claims; builds & maintains PTD benefit plans; handles all Lump Sum Advancements LSA’s related to PTD benefit plans.
Performs non-claims management functions: provides information/support to team members; explains BWC laws, policies, procedures, & processes to BWC customers; provides information for hearing proceedings regarding BWC claims; facilitates employer, injured worker and provider navigation through OhioBWC website; makes presentations to BWC customers through seminars & workshops; facilitates internal interpreter services for non-English speaking injured workers and employers; participates on work groups, committees (e.g., Safety Committee), and QStP teams; meets with customers who visit service office for information and assistance; attends training sessions provided by Performance & Support Department (e.g., refresher courses, legal updates, policy updates.
Minimum Qualifications:
Unless required by legislation or union contract, starting salary will be set at the lowest rate of the salary range with gradual increases after completing probation and following successful annual performance evaluations.
Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute.
- Or 36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute.
- Or 24 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 24 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) &/or as BWC Employer Service Representative, 63521, (i.e., providing information & assistance &/or responding to complaints, questions & inquiries from customers regarding workers’ compensation coverage, established binder/applications maintenance, demographics, supplemental & legal entities, manual classifications, debits/credits & payroll reports &/or various BWC programs & research & explain employer refunds, attorney general balances, payments made to policies &/or divided credits).
- Or 12 mos. exp. as Workers’ Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers’ Compensation).
- Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &/or as Workers’ Compensation Claims Assistant, 16720 &/or as Workers’ Customer Service Representative, 64451 &/or as Workers’ Compensation Employer Service Representative, 63521.
- Or equivalent of Minimum Class Qualifications For Employment noted above.
Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment.
Major Worker Characteristics:
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*; MIRA reserving*; Skill in: operation of a personal computer; typing; use of Microsoft Office software (e.g., Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., V3, WCIS, , Intrafin, DOGS, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, microfiche, phone); communication skills (e.g., listening, writing, reading, phone etiquette); use of internet; Ability to: define problems, collect data, establish facts, & draw valid conclusions; read & understand medical reference manuals & reports; gather, collate, & classify information about data, people, or things; demonstrate dexterity in use of hands & fingers; respond to sensitive inquiries from & contacts with injured workers, employers, providers or their representatives, & the public; multitask by utilizing good organizational skills & time management; answer routine & technical inquiries from injured workers, employers, medical providers & public*; make proper referrals (within agency & external sources)*; diffuse potentially volatile situations; present information to others; work with a team; use ICD coding manuals*; generate properly formatted business correspondence; read and understand compensation payment plan screens* prioritize caseload based on performance goals interpret Data Warehouse reports*.
(*)Developed after employment.
Supplemental Information:
Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.
Online applications will be accepted only for these positions. All communication and/or status updates regarding this position will be relayed electronically.
If you are a current BWC employee and have passed the exam for this classification, you will not be required to test for this position. If you are not a current BWC employee and you have passed the exam for this classification within the last 12 months, you will not be required to test for this position.
Status of posted positions : You can check the status of your application online by signing in to your profile. Jobs to which you’ve applied will be listed. The application status is shown to the right of the position title and application submission details. Questions pertaining to things other than your application status can be directed to: a81496@bwc.state.oh.us .
EDUCATIONAL TRANSCRIPT REQUIREMENT:
BWC requires an official transcript for any applicant claiming to meet the minimum qualifications based on educational achievement. A transcript is only considered “official” if it is verifiable through the educational institution that awarded it (e.g., contains institution watermark, ink stamp, embossed stamp, registrar contact information). If provided from an on-line transcript clearinghouse the transcript must contain clearinghouse contact information so that it can be verified. Printouts of course information available to the student through the institution’s website are NOT considered an official transcript. In order for education to be taken into consideration during the application screening process, BWC employees must have an official transcript on file with the Personnel & Benefits department by the deadline date on the job posting. Applicants not currently employed by BWC must attach a copy of the transcript(s) to their application, however, an official transcript will be required if invited to interview for the job opening.
Position may require travel; therefore, persons occupying this position must be able to provide own transportation &/or legally operate a state-owned vehicle.
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