WC Medical Claims Specialist Supervisor- PN: 20068334

State of Ohio Jobs
Columbus, OH 43215 (Downto…
14 days ago

Job Description

Primary Location: United States of America-OHIO-Franklin County-Columbus
Work Locations: William Green Building 30 West Spring Street Columbus 43215-2256
Organization: Workers' Compensation
Classified Indicator: Classified
Bargaining Unit / Exempt: Exempt
Schedule: Full-time
Work Hours: 40
Compensation: $29.49 - $42.01
Unposting Date: Apr 28, 2024, 10:59:00 PM
Primary Job Skill: Claims Examination
Technical Skills: Claims Examination
Professional Skills: Analyzation, Attention to Detail, Teamwork, Time Management
Agency Contact Name: Matthew Palte - HCM Sr. Analyst
Agency Contact Information: A85602@bwc.ohio.gov

WC Medical Claims Specialist Supervisor- PN: 20068334

(240003WY)
Job Duties

A Little About Us:
With roughly 1,600 employees in 11 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 employees strive to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee resource groups, participate in online forums discussing society’s impact on our services and workplace, 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.

What our employees have to say:
BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:

  • I have worked for BWC for 27 years and it has been a positive experience.
  • I have worked with a wonderful group of people from management down to my co-workers.
  • So much opportunity for growth here, the leadership from top to bottom is stellar, the employees have pride in our agency - a great place to work!
  • Coming up on 30 years and still love what I do and where I work!
  • I find BWC to be a dynamic agency that not only provides a much-needed public service, but also has a culture of learning and development where employees are encouraged to be a part of the agency as a whole.

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!

BWC is currently operating under a hybrid schedule that can incorporate both teleworking and in-office hours. Employees must be able to report to the office when requested by management &/or for their initial job training.

What You'll Be Doing:

  • Oversees implementation of new/revised billing processes and monitors existing billing procedures to ensure compliance with applicable state, federal & Agency laws, rules & regulations as they relate to medical payment/medical subrogation.
  • Coordinates resolution of complex claim/billing issues as they relate to medical billing payment and/or subrogation.
  • Provide/maintain reporting of business production and activities surrounding bill payment and subrogation activity.
  • Identify training opportunities and assist in development of training material.

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.
Qualifications

24 mos. exp. in supervisory level position within Ohio Bureau Of Workers' Compensation, 12 mos. of which involved telephoned, in-person &/or written contact with providers, claimants, employees, public officials, attorneys &/or general public to provide information & answer inquiries concerning various operations, services &/or policies & procedures of agency.

  • Or 24 mos. exp. in managing medical-only &/or lost-time claims, serving as primary decision maker to include making initial determination of claim, having overall responsibility & accountability of claims & management of claims to desired outcome.

  • Or 24 mos. exp. in private insurance organization as claims representative, nurse, or rehabilitation specialist; 6 mos. exp. providing work direction to claims processing staff.

  • Or completion of undergraduate program core coursework in business administration or related field of study.

  • Or equivalent of Minimum Class Qualifications For Employment noted above.

Technical Skills: Claims Examination

Professional Skills: Analyzation, Attention to Detail, Teamwork, Time Management


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.


Knowledge of
: workers’ compensation laws, policies & procedures governing adjudication & management of workers’ compensation medical claims*; BWC & Policy & Support Division policies & standard operating procedures*; supervisory principles & techniques*; employee training & development; English grammar; oral & written business communication; public relations; fundamental mathematics (i.e. addition, subtraction, multiplication, division, fractions, decimals, & percentages); standard business practices, principles of customer service; MCOs*; collective bargaining agreements*.

Skill in: personal computer & software*.

Ability to: define problems, collect data, establish facts & draw valid conclusions; read & understand medical reference manuals; write meaningful, accurate & concise reports; gather, collate & classify information about data, people or things; respond to sensitive inquiries from & contacts with claimants, employers & health-care providers; establish friendly environment as manager of a unit


(*)Developed after employment.


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 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 Transcript Requirement
In order 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.


Background Check Information


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.

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.

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

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