What are the responsibilities and job description for the WC Medical Claims Specialist (Pharmacy Claims Specialist) position at Ohio Department of Commerce?
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 :
- 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.
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
Qualifications
To Qualify, You Must Demonstrate :
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
