Cincinnati WC Claims Specialist (PN: 20069655)

Overview BWC’s core hours of operation are Monday‑Friday from 8:00am to 5:00pm, however daily start/end times may vary based on operational need across BWC departments. Most positions perform work on‑site at one of BWC’s seven offices across the state. BWC offers flex‑time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex‑time schedules are based on operational need and require supervisor approval. What You’ll Be Doing Manages a caseload of Workers’ Compensation claims: communicates, coordinates and collaborates with internal and external stakeholders such as the Disability Management Coordinator, Medical Service Specialist, Managed Care Organization, Employer Management team, Safety & Hygiene, injured workers, employers, Third Party Administrators and rehabilitation personnel to set return‑to‑work expectations. Performs initial and subsequent claims investigation and determination within prescribed timeframes, contacting parties involved, completing investigation to determine information pertinent to management of claim. Processes various types of compensation ranging from Temporary Total Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests; addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders and referrals to the Industrial Commission of Ohio. Responds to customer inquiries. Follows Ohio Revised Code and BWC policies and procedures. Communicates with legal representatives, employers, claimants, etc. Qualifications 36 months experience in a private insurance organization as a claims representative or equivalent position; successful completion of one typing course or demonstration of 35 words per minute. Completion of undergraduate core coursework in business, humanities, social & behavioral science, education or related field; successful completion of one typing course or demonstration of 35 words per minute. 24 months experience as a Workers’ Compensation Claims Assistant (classification 16720) with responsibilities including document completion, ICD/CPT coding, and claim management. 24 months experience as a BWC Customer Service Representative (classification 64451) or Employer Service Representative (classification 63521) with duties such as providing information, answering complaints and reviewing claims. 12 months experience as a Workers’ Compensation Medical Claims Specialist (classification 16721) managing medical‑only claims and payments. Combination of at least 36 months experience in private insurance claims, a Workers’ Compensation Claims Assistant, or a Workers’ Customer Service Representative or Employer Service Representative. Equivalent experience as determined by Minimum Class Qualifications for Employment. Job Skills Claims Examination Major Worker Characteristics Knowledge of: workers' compensation laws, policies and procedures; eligibility criteria; English grammar and spelling; oral and written business communication; public relations; mathematical skills; interviewing techniques; internet search; medical terminology; medical diagnosis coding; Industrial Commission processes; claims reserving. Skill in: operation of a personal computer, typing, Microsoft Office, BWC‑specific software (Workers’ Compensation Claims Management System, Intrafin, FMS fraud system), office machinery, communication skills, use of internet. Ability to: define problems, collect data, establish facts, draw valid conclusions; read and understand medical reference manuals; respond to sensitive inquiries from injured workers, employers, providers and the public; answer routine and technical inquiries; make proper referrals; diffuse volatile situations; present information; work with a team; use ICD coding manuals; generate business correspondence; read compensation payment plan screens; interpret Cognos reports. Agency Contact Mia Truss‑Davis – HCM Sr. Analyst: View email address on click.appcast.io Job Details Unposting Date: Jun 4, 2026, 11:59:00 PM Primary Location: United States of America–OHIO–Hamilton County–Cincinnati Compensation: $25.77 - $33.52 Schedule: Full‑time Work Hours: 40 Classified Indicator: Classified Union: OCSEA Equal Opportunity Statement BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. #J-18808-Ljbffr Ohio BWC (official)