Columbus - WC Medical Claims Specialist - PN: 20068287

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:

• Manage Medicare medical subrogation claims, including reviewing Center for Medicare/Medicaid (CMS) conditional payment summaries, determining relatedness to workers’ compensation injuries, processing payments, and preparing disputes or appeals.
• Strong communication skills, including professional written communication drafting persuasive disputes/appeals and formal correspondence that clearly establish claim payment disqualification, citing applicable policy (e.g., BWC policies), and organize supporting evidence (remits, checks, medical records) into comprehensive, professional packets.
• Track, update, and maintain case activity in CoreSuite Medicare Tracker, monitor Open Debt Reports, and follow up with Medicare contractors on errors, re-openings, or updates.
• Organizational and multitasking skills, including prioritizing work, tracking case actions, time management, and maintaining accurate documentation

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.

Major Worker Characteristics:

Knowledge of: (1)Workers’ Compensation policies & procedures & laws & regulations governing adjudication & management of medical claims*, (2)Ohio Revised Code*, (3)eligibility criteria & workers’ compensation processing procedures*, (4) Medical Services & Medical Billing & Adjustments policies & standard operating procedures*, (5*) Medicare Secondary Payer Act* (5*6)oral & written business communication, (7)English grammar & spelling, (8)public relations, (9)principles of customer service, (10)addition, subtraction, multiplication, division, fractions, decimals & percentages, (11)standard business practices, (12)medical terminology*, (13)medical diagnosis coding*, (14)Industrial Commission processes*, (15)CAM edits & explanations of benefit*.

Skill in: (1)operation of personal computer & peripherals (e.g. printer, fax, scanner, copier), (2)use of Microsoft Office products (e.g., Word, Access, Excel, Outlook), (3)use of BWC-specific software (e.g., Hyland OnBase, CoreSuite, CAM, OHIO.BWC.gov, COR,)*, (4)communication skills (e.g., listening, writing, reading, phone etiquette)*, (5)use of internet search engines & navigation*, (6)se of calculator*, (7)use of 10-key*.

Ability to: (1)communicate (written or oral) professionally with injured workers, employers, MCOs, legislators, providers & their representatives & the public, (2)deal with many variables & determine specific action, (3)read & understand technical reference manuals (e.g., MCO policy reference guide), (4)define problems, collect data, establish facts & draw valid conclusions, (5)write clear, concise & professional correspondence & reports, (6) assess questions & provide appropriate referral or information, (7)develop good rapport with internal & external customers, (8)gather, collate & classify information about data, people or things, (9)respond to sensitive inquiries from & contacts with injured workers, employers, health care professionals, (10)multitask by utilizing good organizational skills & time management, (11)make proper referrals (within agency & external sources), (12) work as a team, (13)prioritize workload based on performance goals, (14)interpret data warehouse reports*.

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.

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.

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.

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.