Cleveland - WC Claims Specialist - PN: 20068905, 20068930, 20068979 & 20069000

Job Title Cleveland – WC Claims Specialist (Job Numbers: 20068905, 20068930, 20068979, 20069000; 260004HS) Organization Workers' Compensation Location Lausche Building, 615 West Superior Avenue, Cleveland, OH 44113-1879, United States (Cuyahoga County) Union

OCSEA

Compensation $26.54 – $34.53 per hour Schedule Full-time, 40 hours per week Primary Job Skill Claims Examination Responsibilities Manage a caseload of Workers’ Compensation claims, communicating, coordinating and collaborating with internal and external stakeholders to set return‑to‑work expectations. Perform initial and subsequent claims investigation and determination within prescribed timeframes, contacting parties and completing investigations to determine jurisdiction, coverage, causality, compensability, claim data accuracy, current work status, job description, salary continuation, physical demands and work history. Process various types of compensation—including Temporary Total, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, and Lump Sum Advancement requests—and address subsequent requests by parties to the claim via due process notification, investigation, BWC orders, and referrals to the Industrial Commission. Respond to customer inquiries. Follow Ohio Revised Code and BWC policies and procedures. Communicate with legal representatives, employers, claimants, and others. Qualifications 36 months’ experience working in a private insurance organization as a claims representative or equivalent position; successful completion of a typing course or ability to type 35 words per minute. Or completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of a typing course or ability to type 35 words per minute. Or 24 months’ experience as a Workers' Compensation Claims Assistant, 16720, providing assistance to claims field operations or medical claims teams, ensuring document compliance, determining allowances using ICD/CPT code manual, and managing a caseload of self‑insured claims. Or 24 months’ experience as a BWC Customer Service Representative, 64451, or as a BWC Employer Service Representative, 63521, providing information, assistance and responding to inquiries related to workers’ compensation coverage, legal entities, payroll reports, and BWC programs. Or 12 months’ experience as a Workers' Compensation Medical Claims Specialist, 16721, managing a caseload of medical‑only claims and paying claims. Or a combination of at least 36 months’ experience in a private insurance organization as a claims representative or equivalent position and experience as a Workers' Compensation Claims Assistant, 16720, or as a Workers' Customer Service Representative, 64451, or as a Workers’ Compensation Employer Service Representative, 63521. Or equivalent of the minimum class qualifications noted above. Job Skills Claims examination. Major Worker Characteristics Knowledge of workers' compensation laws, policies and procedures; eligibility criteria and procedures; English grammar and spelling; oral and written business communication; public relations; basic mathematics; interviewing techniques; internet search engines and navigation; medical terminology; medical diagnosis coding; Industrial Commission processes; claims reserving. Skill in operating a personal computer; typing; use of Microsoft Office (Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (Workers’ Compensation Claims Management System, Intrafin, FMS fraud system); operation of office machinery; communication skills; use of internet. Ability to define problems, collect data, establish facts, draw valid conclusions; read and understand medical reference manuals, gather, collate and classify information; respond to sensitive inquiries; make referrals; diffuse volatile situations; present information; work in a team; use ICD coding manuals; generate business correspondence; read payment plan screens; interpret Cognos reports. Benefits Medical coverage Free dental, vision and basic life insurance premiums after completion of eligibility period Paid time off (vacation, personal, sick leave) and 11 paid holidays per year Childbirth, adoption, and foster care leave Education and development opportunities (employee development funds, public service loan forgiveness, etc.) Public retirement systems (OPERS, STRS, SERS, HPRS) and optional deferred compensation (Ohio Deferred Compensation) 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. 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. 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. Drug-Free Workplace The State of Ohio is a drug‑free workplace which prohibits the use of marijuana (recreational marijuana/non‑medical cannabis). This position may be subject to additional restrictions pursuant to the State of Ohio Drug‑Free Workplace Policy (HR‑39). #J-18808-Ljbffr State of Ohio