Cincinnati- WC Claims Specialist PN - 20069048 (250005D4)

Organization

: Workers' CompensationAgency Contact Name and Information: Matthew Palte- HCM Sr. Analyst: Matthew.P.2@bwc.ohio.gov

Unposting Date

: Jul 28, 2025, 3:59:00 AM

Work Location

: Cincinnati Claims Office 135 Merchant Street Springdale 45246

Primary Location

: United States of America-OHIO-Hamilton County-Springdale Compensation: $25.77 - $33.52

Schedule

: Full-timeWork Hours: 40Classified Indicator: ClassifiedUnion: OCSEA

Primary Job Skill

: Claims ExaminationTechnical Skills: Claims ExaminationProfessional Skills: Analyzation, Attention to Detail, Customer Focus, Responsiveness, Written Communication Agency Overview

A Little About Us:
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.

Our Culture:
BWC is a dynamic organization that offers career opportunities across many different disciplines. BWC strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums and learn about how different perspectives can improve leadership skills.

Our Vision:
To transform BWC into an agile organization driven by customer success.

Our Mission:
To deliver consistently excellent experiences for each BWC customer every day.

Our Core Values:
One Agency, Personal Connection, Innovative Leadership, Relentless Excellence.

Job Description

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 Our Employees Have to Say:
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.

If you are interested in helping BWC grow, please click this link to read more, and then come back to this job posting to submit your application!

What You’ll Be Doing:

· Reviews incoming claims documents (e.g. appeals, IC orders, C92/C92As) to determine required action; requests medical documentation & wage information from (e.g. IW rep, IW’s, Employers, Employers Rep) as appropriate

· Assures all information on initial claims applications is complete and accurate when entering information into Claims Management System

· Responds to customer inquiries (e.g. general claims inquiries) in person, via phone, fax &/or e-mail, written with 24 hours

· Contacts appropriate individuals to obtain missing information.

· Ability to manage a worklist/caseload that consists of C92/C92A applications,, wages, IC orders, appeals, C92/C92A exams etc.

· Ability to issue tentative orders, summarize IC orders and make payments.

Why Work for the State of Ohio

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
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 (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)

*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

Qualifications

36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate 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 one typing course or demonstrate ability to type 35 words per minute.

-Or 24 mos. exp. 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 24 mos. exp. 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) &/or as BWC Employer Service Representative, 63521, (i.e., 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).

-Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims & paying medical claims for Ohio Bureau Of Workers' Compensation).

-Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &/or as Workers' Compensation Claims Assistant, 16720 &/or as Workers' Customer Service Representative, 64451 &/or as Workers’ Compensation Employer Service Representative, 63521.

-Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment.

Job Skills: Claims Examination

Major Worker Characteristics:

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*; 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 (e.g., Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., Workers’ Compensation Claims Management System, Intrafin, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., 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*; make proper referrals (within agency & external sources)*; diffuse potentially volatile situations; present information to others; work with a team; use International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.

Supplemental Information

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: eeodept@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.

All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.

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.

ADA Statement

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.

Drug-Free Workplace

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.

Set your job search on autopilot

Fresh Jobs

Cincinnati, OH District Sales Manager

PHARMACIST-CINCINNATI

Relationship Banker - Greater Cincinnati Market - Cincinnati, OH

Relationship Banker - Cincinnati North Market - Cincinnati, OH

Valet Attendant - Cincinnati

Valet Attendant - Cincinnati

Cincinnati Technician 3

PHARMACIST-WEST CINCINNATI

Carpenter - Commercial Construction Cincinnati

Bartender (PT) - Graduate Cincinnati

Territory Sales Representative - Cincinnati

Service Technician - Cincinnati, OH

Outreach Manager (OH, Cincinnati)

Signals - Maintainer - Cincinnati, OH

STNA HOSPICE OF CINCINNATI

Service Technician - Cincinnati, OH

Service Manager- Cincinnati, OH

Carpenter - Commercial Construction Cincinnati

Project Engineer - Cincinnati Region

Valet Attendant (PT) - Cincinnati

District Manager - Cincinnati (CRM)

Territory Sales Consultant - Cincinnati

Security Officer - Cincinnati - 900010

Housekeeping Supervisor - Graduate Cincinnati

Carpenter - Commercial Construction Cincinnati

Sales Account Manager - Cincinnati

Room Attendant (PT) - Graduate Cincinnati

Inside Sales Representative - Cincinnati, OH

Personal Banker ll - Northwest Cincinnati

Pharmaceutical Sales Associate - Cincinnati, OH

Personal Banker - North Cincinnati Region

Guest Service Supervisor - Graduate Cincinnati

Lead Teacher, Childtime of Cincinnati

Inside Sales Representative - Cincinnati, OH

Cincinnati Area Restaurant General Manager

Cincinnati Area Restaurant Assistant Manager

Senior CoreValve Therapy Consultant - Cincinnati

Director - Propulsion Industrial team - Cincinnati

Maintenance Field Tech - Cincinnati OH

Mobile Phlebotomist - Cincinnati, OH (Temporary)

Senior CoreValve Therapy Consultant - Cincinnati

Packer Labor 2nd Shift Cincinnati OH

Personal Banker I - Northern Cincinnati Region

Personal Banker II - Northern Cincinnati Region

Union HVAC/Refrigeration Technician - Cincinnati, OH

Maintenance Tech 2 - Cincinnati Area Racks

Cincinnati- WC Claims Specialist PN - 20069048

Commercial Service Account Manager - Cincinnati, OH

Sales Lead- LOS - Cincinnati Premium Outlets

Personal Banker I - Northern Cincinnati Region