What are the responsibilities and job description for the WC Medical Claims Specialist (Pharmacy Claims Specialist) - 20068335 position at Ohio BWC (official)?
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.
What You’ll Be Doing
3 courses or 9 months training or 9 months experience in English composition or grammar AND 3 courses or 9 months training or 9 months experience in accounting, bookkeeping or general business mathematics AND 3 courses or 9 months training or 9 months experience in communication or public speaking or 9 months experience involving contact with injured workers, employers, legislators, providers or their representatives & public AND successful completion of one typing course or demonstrate ability to type 35 words per minute.
OR 12 months experience as Workers' Compensation Claims Assistant, 16720, (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self-insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law).
OR 12 months experience as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations).
Position Specific Minimum Qualifications
Note: Classifications may require use of proficiency demonstration to determine minimum class qualifications for employment.
Job Skills: Claims Examination
Organization
Workers' Compensation
Agency Contact Name and Information
a85603@bwc.state.oh.us
Unposting Date
Feb 25, 2025, 11:59:00 PM
Work Location
William Green Building
Primary Location
United States of America-OHIO-Franklin County-Columbus
Compensation
$23.12
Schedule
Full-time
Classified Indicator
Classified
Union
OCSEA
Primary Job Skill
Claims Examination
Technical Skills
Claims Examination, Pharmacy
Professional Skills
Attention to Detail, Customer Focus, Responsiveness, Teamwork
Agency Overview
A Little About Us:
With roughly 1,500 employees in 7 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:
What You’ll Be Doing
- Assist with inquiries received in writing & by telephone customers related to pharmacy benefits.
- Review medication decisions in orders, motions, and prior authorizations to determine prescription benefit coverage.
- Perform processing of prior authorization requests and Drug Utilization Review.
- Monitor status of appeals & outcomes from Industrial Commission hearings.
- Manages imaging system to maintain documents being sent to the pharmacy department.
3 courses or 9 months training or 9 months experience in English composition or grammar AND 3 courses or 9 months training or 9 months experience in accounting, bookkeeping or general business mathematics AND 3 courses or 9 months training or 9 months experience in communication or public speaking or 9 months experience involving contact with injured workers, employers, legislators, providers or their representatives & public AND successful completion of one typing course or demonstrate ability to type 35 words per minute.
OR 12 months experience as Workers' Compensation Claims Assistant, 16720, (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate & in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT & taking appropriate action on self-insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers & updating claim information & managing caseload of self-insured medical & disability claims to ensure compliance with Ohio Workers' Compensation Law).
OR 12 months experience as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &/or answering complaints, questions &/or telephone inquiries &/or written correspondence from customers pertaining to claims status or procedures, reviewing & analyzing claims, referring customers to available community services, & conducting telephone interviews with citizens reporting fraud allegations).
Position Specific Minimum Qualifications
Note: Classifications may require use of proficiency demonstration to determine minimum class qualifications for employment.
Job Skills: Claims Examination
Organization
Workers' Compensation
Agency Contact Name and Information
a85603@bwc.state.oh.us
Unposting Date
Feb 25, 2025, 11:59:00 PM
Work Location
William Green Building
Primary Location
United States of America-OHIO-Franklin County-Columbus
Compensation
$23.12
Schedule
Full-time
Classified Indicator
Classified
Union
OCSEA
Primary Job Skill
Claims Examination
Technical Skills
Claims Examination, Pharmacy
Professional Skills
Attention to Detail, Customer Focus, Responsiveness, Teamwork
Agency Overview
A Little About Us:
With roughly 1,500 employees in 7 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:
- 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.
Salary : $23
