Technical Claims Specialist - PN: 20069293

    Highlights

    Ability to: interpret extensive variety of technical & complex material in verbal & written forms; prepare & deliver professional presentations before specialized audiences & public; develop complex reports pertaining to claims, risk, safety & hygiene, medical & managed care; handle highly confidential & sensitive matters with all contacts; strategize for optimum efficiency; practice innovation & be creative in a government environment; delegate appropriately; identify & manage staff performance variances; direct programs; use statistical analysis; analyze customer satisfaction. Major Worker Characteristics: Knowledge of: policies & procedures related to claims operations, risk, safety & hygiene, loss prevention, medical and managed care; state & federal laws governing workers' compensation; management; labor relations; manpower planning; public relations; government structure & process (BWC) ; interviewing; BWC laws ; budgeting; training; loss-prevention principles; BWC programs*; OSHA compliance.

    Numbers & Facts

    LocationOhio, IL

    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. The report-in location will be determined based on the final candidate recommended for the position.

    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:

    • Conduct quality assurance audits of claims and operational processes; identify trends and prepare findings.
    • Monitor compliance with injury management policies and ensure consistent, accurate claims practices statewide.
    • Support updates to policies, procedures, and audit tools; recommend and help implement operational improvements.
    • Provide guidance and clarification to staff and supervisors on policies, procedures, system processes, and operational expectations.
    • Participate in or lead statewide initiatives aimed at improving service quality, consistency, and customer satisfaction.
    • Identify staff skill gaps and collaborate on training recommendations to strengthen performance across service offices.
    • Support administrative tasks, respond to inquiries, and assist with operational research as needed.

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

    • Or 2 yrs. trg. or 2 yrs. exp. in adjusting insurance claims or medical case management in insurance-related field, or rehabilitation case management in insurance related field; 1 course or 3 mos. exp. in employee training & development; 2 courses or 6 mos. exp. in public speaking or communication skills; 1 course or 3 mos. exp. in business/professional writing, English composition or written communication.
    • Or completion of undergraduate core program in business administration, public administration, insurance, risk management, education, communication, social or behavioral science, nursing or health administration (e.g., rehabilitation counseling) or related field of study; 1 course or 3 mos. exp. in auditing principles & procedures; 1 course or 3 mos. exp. in employee training & development; 1 course or 3 mos. exp. in speech &/or oral communication or public speaking; 1 course or 3 mos. exp. in business/professional writing, English composition, or written communication.
    • Or 36 mos. exp. as supervisor within Ohio Bureau of Workers' Compensation responsible for implementation, evaluation & monitoring of technical programs (e.g., new or revised claims processing program, programs to identify & deter fraudulent claims activity, premium discount program).
    • Or equivalent of Minimum Class Qualifications for Employment noted above.

    Job Skills: Claims Examination

    Major Worker Characteristics:

    Knowledge of: policies & procedures related to claims operations, risk, safety & hygiene, loss prevention, medical and managed care; state & federal laws governing workers' compensation; management; labor relations; manpower planning; public relations; government structure & process (BWC); interviewing; BWC laws; budgeting; training; loss-prevention principles; BWC programs*; OSHA compliance.

    Skill in: management of diverse field operations and staff; leadership; communicating with diverse audiences; directing change; creativity & innovation; operation of a PC.

    Ability to: interpret extensive variety of technical & complex material in verbal & written forms; prepare & deliver professional presentations before specialized audiences & public; develop complex reports pertaining to claims, risk, safety & hygiene, medical & managed care; handle highly confidential & sensitive matters with all contacts; strategize for optimum efficiency; practice innovation & be creative in a government environment; delegate appropriately; identify & manage staff performance variances; direct programs; use statistical analysis; analyze customer satisfaction.

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