Claims Examiner 2 - PN 20064858

State of Ohio
Columbus, Ohio
Full Time

Email Address

Apply Now

What You'll Do:

The Industrial Commission, office of Medical Services is seeking an experienced claims examiner with a customer focused background who can handle assigned claims following agency guidelines and procedures, someone who can adapt to change and remain professional while working with OIC customers. The selected individual must have strong customer service skills, must pay attention to details and produce accurate work product and have the ability to multi-task, prioritize and manage time effectively.

Under general supervision, prepares claims for exams and file reviews using personal computer applications (CAS, ECM, Case Manager, SharePoint, ICON, BWC applications) for data retrieval, verification, resolution, tracking & organization.

Captures issues, tracks PCNs & updates claim / exam information (exam dates, medical intent, expiration dates, addresses, risk & representative changes, etc.) on CAS.
Reviews / analyzes claim documents and images according to established Workers' Compensation laws & Industrial Commission rules, policies & procedures to determine pertinent data (filing & order dates, claim allowances, involved parties, providers, exam location, expiration dates, etc.).
Schedules exams, recruits & selects providers, updates provisional spreadsheet, assists with completion of provider enrollment forms & exam fee negotiations.
Processes cancellations & no shows fees.
Approves travel reimbursement.
Generates correspondence: notice of exam, exam referral letter & worksheets, statement of facts / specialist packet, fee bill, cancellation / reschedule letters, etc. & mails accordingly.

See the attached position description for more details regarding this position.

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.

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.

Formal education in arithmetic that includes addition, subtraction, multiplication, division, fractions, decimals & percentages & in reading, writing & speaking common English vocabulary; 3 mos. trg. or 3 mos. exp. in office practices & procedures.