Toledo- WC Claims Specialist PN: 20069759 &20069837

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.

Professional Skills: Analyzation, Building Trust, Customer Focus

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.

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.

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*; claims 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., Workers’ Compensation Claims Management System, Intrafin, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, 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; respond to sensitive inquiries from & contacts with injured workers, employers, providers or their representatives, & the public; 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 International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.

(*) Developed after employment

BWC OCSEA Selection Rights:
This position 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 this position.

Salary Information:
Unless required by legislation or union contract, candidates will start at the lowest rate of the salary range associated with this position.

Transportation:
Position may require travel; therefore, persons occupying this position must be able to provide own transportation &/or legally operate a state-owned vehicle.

Educational Transcripts:
For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.

Required Background Check:
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.

EEO & ADA Statement:
The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.

The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request a reasonable accommodation due to disability, please contact ADA Coordinator Kathleen Bourke at 614-644-7811 or by email to: [email protected].