Toledo: WC Claims Specialist- PN: 20069832

A Little About Us:
With roughly 1,600 employees in 11 offices across Ohio, BWC is the state agency that cares for Ohio workers by promoting a culture of safety at work and at home and ensuring quality medical and pharmacy care is provided to injured workers.
For Ohio employers, we provide insurance policies to cover workplace injuries and safety and wellness services to prevent injuries.
Our Culture: BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC employees strive to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee resource groups, participate in online forums discussing society's impact on our services and workplace, and learn about how different perspectives can improve leadership skills.
Our Vision:
To transform BWC into an agile organization driven by customer success.
Our Mission:
To deliver consistently excellent experiences for each BWC customer every day.
Our Core Values:
One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.
What our employees have to say: BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:

• I have worked for BWC for 27 years and it has been a positive experience.
• I have worked with a wonderful group of people from management down to my co-workers.
• So much opportunity for growth here, the leadership from top to bottom is stellar, the employees have pride in our agency - a great place to work!
• Coming up on 30 years and still love what I do and where I work!
• I find BWC to be a dynamic agency that not only provides a much-needed public service, but also has a culture of learning and development where employees are encouraged to be a part of the agency as a whole.

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!
BWC is currently operating under a hybrid schedule that can incorporate both teleworking and in-office hours. Employees must be able to report to the office when requested by management &/or for their initial job training.
What You'll Be Doing:

• Manages a caseload of Workers' Compensation claims: Communicates, coordinates & collaborates with internal & external stakeholders (e.g. Disability Management Coordinator [DMC], Medical Service Specialist [MSS], Managed Care Organization [MCO], Employer Management [EM] team, Safety & Hygiene, injured workers, employers, Third Party Administrators [TPA] & rehabilitation personnel) in order to set return to work expectations.
• Performs initial/subsequent claims investigation & determination within prescribed timeframes:Contacts parties involved in claim process; 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).
• Reviews claims & claim reserves for possible settlements & referrals; ensures data integrity associated with claim reserve elements; maintains the various Workers' Compensation Claims Management Systems correct claims information including claim reserve 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);
• Evaluates information & issues orders, makes claim allowance decisions in regards to Workers' Compensation law &/or policy develops, implements, customer care plan on all eligible claims through collaboration with MCOs (e.g. Return to Work); processes various types of compensation.
• Responds to customer inquiries
• Follows Ohio Revised Code and BWC policies and procedures
• Communicates with legal representatives, employers, claimants, etc.

What's in it for you:
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

• Quality, affordable, and competitive medical benefits are offered through the available Ohio Med plans.

Dental, Vision and Basic Life Insurance

• Dental, vision, and basic life insurance premiums are free after completed eligibility period . Length of eligibility period is dependent on union representation.

Time Away From Work and Work/Life Balance

• Paid time off, including vacation, personal, and sick leave
• 11 paid holidays per year
• Childbirth/Adoption leave

Employee Development Funds

• The State of Ohio offers a variety of educational and professional development funding that varies based on whether you are a union-exempt employee or a union-represented employee.

Ohio Public Employees Retirement System

• OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee's salary. Visit the OPERS website for more information.

Deferred Compensation

• The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.

Qualifications
Required Experience and/or Education:

• 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.
Preferred Technical Skills: Claim Examination
Preferred Professional Skills: Analyzation, Critical Thinking, Time Management