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

Cleveland - WC Claims Specialist Organization: Workers' Compensation Agency Contact Name and Information: Mia Truss-Davis - HCM Sr. Analyst: View email address on click.appcast.io Work Location: Lausche Building 615 West Superior Avenue Cleveland 44113-1879 Primary Location: United States of America-OHIO-Cuyahoga County-Cleveland Compensation: $26.54 - $34.53 Schedule: Full-time Work Hours: 40 Classified Indicator: Classified Union: OCSEA Primary Job Skill: Claims Examination Technical Skills: Claims Examination, Customer Service Professional Skills: Attention to Detail, Critical Thinking, Teamwork, Time Management, Written Communication Responsibilities Manage a caseload of Workers' Compensation claims Communicate, coordinate, and collaborate with internal & external stakeholders (DMC, MSS, MCO, EM team, Safety & Hygiene, injured workers, employers, TPAs & rehabilitation personnel) to set return-to-work expectations Perform initial and subsequent claims investigation and determination within prescribed timeframes Contact parties involved in claim process and complete investigations to determine information pertinent to claim management (jurisdiction, coverage, causality, compensability, claim data accuracy, work status, job description, salary continuation, physical demands, work history) Process various types of compensation (Temporary Total Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, Lump Sum Advancement requests) Address subsequent requests by parties to claim via due process notification, investigation, BWC orders & referrals to the Industrial Commission (IC) of Ohio Respond to customer inquiries Follow Ohio Revised Code and BWC policies and procedures Communicate with legal representatives, employers, claimants, etc. Qualifications 36 months experience working in a private insurance organization as a claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 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 demonstrate ability to type 35 words per minute 24 months experience as Workers' Compensation Claims Assistant (code 16720) 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 24 months experience as BWC Customer Service Representative (code 64451) 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 (code 63521) 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 12 months experience as Workers' Compensation Medical Claims Specialist (code 16721) managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers' Compensation Any combination of at least 36 months experience working in a private insurance organization as a claims representative or equivalent position &/or as Workers' Compensation Claims Assistant (16720) &/or as BWC Customer Service Representative (64451) &/or as Workers' Compensation Employer Service Representative (63521) Equivalent of Minimum Class Qualifications For Employment noted above Job Skills 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 Mathematical skills: 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 (Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (Workers' Compensation Claims Management System, Intrafin, FMS fraud system); operation of office machinery (calculator, printer, copier, fax, phone); communication skills (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 Benefits Medical Coverage Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including 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, and more) Public Retirement Systems (OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) #J-18808-Ljbffr Ohio Jobs