Find The RightJob.

Cleveland - BWC Fraud Analyst - PN: 20066776

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

What You’ll Be Doing:

Applies claims knowledge to analyze fraud‑detection outputs from crossmatches, data exchanges, and large‑scale data sets, generating actionable investigative leads.
Collaborates with Research Analysts and Intelligence Unit to interpret complex data trends, perform outlier analyses, and enhance fraud‑detection methodologies and tools.
Serves as a liaison between Intelligence Unit and fraud teams to assess investigative needs, refine detection criteria, and support the development of fraud‑prevention strategies.

Works closely with Intelligence Unit Fraud Data Specialists to develop tools, processes, and detection ideas.
Assists in maintaining and supporting fraud‑detection reports, visualizations, and detection programs (e.g., Cognos, Tableau).

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

54 mos. exp. in private insurance organization as claims representative, criminal investigator, rehabilitation case manager or equivalent position; 6 mos. exp. in operation of personal computer; valid driver’s license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment.

Or completion of undergraduate core coursework in business, criminal justice, humanities, social & behavioral science, education or related field; 18 mos. exp. in insurance organization as claims representative, criminal investigator, rehabilitation case manager or equivalent position; 6 mos. exp. in operation of personal computer; valid driver’s license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment .

Or 18 mos. exp. as Workers' Compensation Claims Specialist, 16722, or managing caseload of workers' compensation lost-time disability claims which involved making decision to allow or deny claim, verifying appropriateness of medical treatment & charges, pre-authorized medical treatment, equipment, supplies & special travel arrangements, researching, negotiating, authorizing & issuing settlement of claims &/or conducting field inquiries to accurately assess claim information & resolving disputed condensability & benefit level for Ohio Bureau Of Workers' Compensation; 6 mos. exp. in operation of personal computer; valid driver’s license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment.

Or 18 mos. exp. as BWC Fraud Investigator, 26261. Note: Pursuant to Ohio Administrative Code Chapter 4501 users of system shall adhere to policies & guidelines published in NCIC operating manual, CJIS security policy, LEADS operating manual, LEADS security policy, newsletters, & administrative messages from LEADS, all of which are either available on ODPS/LEADS intranet or disseminated to LEADS agencies; pursuant to LEADS security policy (revised 05/07/03) state & national fingerprint-based record checks must be conducted within 30 days of initial employment or assignment of all personnel, including appropriate IT personnel, having access to LEADS, or to records storage areas containing CCH/II data; minimum check must include submission of both a State of Ohio BCI& I card & an FBI applicant fingerprint card; both completed applicant fingerprint cards must be submitted by employing agency to State of Ohio Bureau of Criminal Identification & Investigation for processing & forwarding to Federal Bureau of Investigation; record of this check must be kept by employing agency & made available to LEADS upon request; fingerprint card returned by Ohio BCI&I is sufficient documentation. Pursuant to Ohio Administrative Code Chapter 4501 terminal agency shall conduct a complete background investigation of all terminal operators including, but not limited to: an applicant fingerprint card submission to BCI&I & FBI, an inquiry of state & national arrest & fugitive files; terminal agency is required to notify CTO of any applicant’s criminal record; existence of a criminal record may result in denial of access.

Job Skills: Investigation

Major Worker Characteristics:

Knowledge of Business, Criminal Justice, Humanities, Social & Behavioral Science Education or related field; BWC Policies & Procedures*, Laws & Regulations related to Adjudication & Maintenance of Workers’ Compensation Claims*; Agency, State & Federal Statutes, rules, regulations & procedures applicable to investigation, evidence gathering & search & seizure*; English; oral & written communication; public relations; interviewing techniques; principles of customer service; fundamental math operations; standard business practices.

Skill in use of personal computer; word processor*; database & spreadsheet software*; statistical analysis, data visualization & analytical software used in Fraud Detection*.

Ability to communicate effectively & professionally with injured workers, employers, legislators, health care providers & public; make complex decisions regarding claims activity; read & understand medical reference manuals; write clear, concise & professional correspondence & reports; collate & classify information about data, people or things; assess immediate situation & make split-second decisions; respond to sensitive inquiries from & contacts with injured workers, employers, legislators, health care providers & members of general public.

(*) Developed after employment.

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 reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox BWCADA@bwc.ohio.gov.

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.

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.

Similar jobs