Workers' Compensation Medical Claims Specialist
Organization : Workers' Compensation
Agency Contact Name and Information : BWC Human Resources, A85773@bwc.state.oh.us
Work Location : William Green Building, 30 West Spring Street, Columbus, 43215-2256
Primary Location : United States of America-OHIO-Franklin County-Columbus
Compensation : $24.16 - $30.55 / Hr.
Schedule : Full-time
Work Hours : 8 : 00 - 5 : 00
Classified Indicator : Classified
Union : OCSEA
Primary Job Skill : Claims Examination
Technical Skills : Business, Claims Examination, Medical
Professional Skills : Analyzation, Attention to Detail, Ethics and Values, Time Management, Written Communication
Job Description
With roughly 1,500 employees in seven 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.
BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include :
- 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.
Qualifications
To qualify, you must clearly demonstrate :
3 courses or 9 months training or 9 months experience in English composition or grammar AND 3 courses or 9 months training or 9 months experience in accounting, bookkeeping or general business mathematics AND 3 courses or 9 months training or 9 months experience in communication or public speaking or 9 months experience involving contact with injured workers, employers, legislators, providers or their representatives & public AND successful completion of one typing course or demonstrate ability to type 35 words per minute.Or 12 months experience 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 months experience 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.Job Skills : Claims Examination
Major Worker Characteristics :
Knowledge of : workers' compensation laws, policies & procedures; eligibility criteria & procedures used for processing workers' compensation medical only claims; principles of customer service; public relations; English grammar & spelling; oral & written business communication; fundamental mathematics (e.g. addition, subtraction, multiplication, division, fractions, decimals & percentages); Workers' Compensation standard business practices; interviewing techniques; internet search engines & navigation; medical terminology; medical diagnosis coding; Industrial Commission processesSkill 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 , BWC Web Site, SharePoint); operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., listening, writing, reading, phone etiquette); use of internetAbility to : define problems, collect data, establish facts, & draw valid conclusions; read, access & understand medical reference manuals & reports; gather, collate & classify information about data, people, or things; communicate effectively and professionally; communicates on sensitive information and inquiries 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; develop good rapport with internal and external customers; utilize ICD coding tools; generate properly formatted business correspondence; prioritize caseload based on performance goals; interpret Data Warehouse reportsDeveloped after employment.)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 : bwcada@bwc.state.oh.us.
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 : Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and / or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.
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.
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.
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.