Claims Examiner 2 - PN 20064858

Mission Statement:

Our mission is to serve injured workers and Ohio employers through expeditious and impartial resolution of issues arising from workers' compensation claims and through the establishment of adjudication policy.

What You'Ll Do:

The Industrial Commission, office of Medical Services is seeking an experienced claims examiner with a customer focused background who can handle assigned claims following agency guidelines and procedures, someone who can adapt to change and remain professional while working with OIC customers.  The selected individual must have strong customer service skills, must pay attention to details and produce accurate work product and have the ability to multi-task, prioritize and manage time effectively.  

Under general supervision, prepares claims for exams and file reviews using personal computer applications (CAS, ECM, Case Manager, SharePoint, ICON, BWC applications) for data retrieval, verification, resolution, tracking & organization.  

• Captures issues, tracks PCNs & updates claim / exam information (exam dates, medical intent, expiration dates, addresses, risk & representative changes, etc.) on CAS.
• Reviews / analyzes claim documents and images according to established Workers' Compensation laws & Industrial Commission rules, policies & procedures to determine pertinent data (filing & order dates, claim allowances, involved parties, providers, exam location, expiration dates, etc.).  
• Schedules exams, recruits & selects providers, updates provisional spreadsheet, assists with completion of provider enrollment forms & exam fee negotiations. 
• Processes cancellations & no shows fees. 
• Approves travel reimbursement. 
• Generates correspondence: notice of exam, exam referral letter & worksheets, statement of facts / specialist packet, fee bill, cancellation / reschedule letters, etc. & mails accordingly.

See the attached position description for more details regarding this position.

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.

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.

Formal education in arithmetic that includes addition, subtraction, multiplication, division, fractions, decimals & percentages & in reading, writing & speaking common English vocabulary; 3 mos. trg. or 3 mos. exp. in office practices & procedures. 

-Or 6 mos. exp. as Claims Examiner 1, 16791.

-Or equivalent of Minimum Class Qualifications for Employment noted above.

Job Skills: Claims Examination

Technical Skills: Clerical & Data Entry, Customer Service, Scheduling

Professional Skills: Attention to Detail, Proofreading, Time Management, Written Communication

This position is filled through an assessment consisting of a computer-based test, written exercise, and structured interview. The assessment consist of a computer-base test and structured interview in person at the William Green Building in Columbus, Ohio. 

The hourly wage for this position is not negotiable. For applicants who are not current State of Ohio employees, the starting wage will be the hourly rate listed on this posting. Successful employees will move up a step in the salary range within one year, and in most cases within four to six months, with subsequent step increases occurring annually.

For internal applicants, the position will be filled pursuant to legislation or the provision of the OCSEA/AFSCME Contract.

ADA Statement: The Industrial Commission 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. To request a reasonable accommodation due to a disability please contact the ADA Coordinator, at 614-466-2765 (voice) or by email to: diversity@ic.ohio.gov, as-soon-as possible but at least 14 days prior to the scheduled event.

Background Check Information Statement: The final candidate selected for the position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.