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|POSITION DESCRIPTION | |

| |DEPT ID/BUDGET CODE BWC600935 |

|Class #: 16720 |Title: Workers’ Compensation Claims Assistant |PN:20069690 |

|DIVISION |DEPARTMENT / WORK UNIT |COUNTY OF EMPLOYMENT |

|Claims Services |Mansfield Service Office |Richland |

|New Position | Update |Reclassification (note previous class here) | Position hyperlinked to org |

| | | |tree? |

|WORKING TITLE OF POSITION |POSITION NO. AND TITLE OF IMMEDIATE SUPERVISOR |

|Claims Assistant |(see org tree) |

| Permanent | Classified |FLSA status: OT Eligible OT Exempt |Bargaining Unit: 09 |

| | | | |

|Temporary |Unclassified |If OT Exempt, exemption type(s): | |

|Intermittent | |Exec Admin Prof High Comp |Page 1 of 2 |

|NORMAL WORKING HOURS (Explain unusual or rotating shift): |

|FROM: 8:00am TO: 5:00pm |

|% |Job Duties in Order of Importance |Knowledge, Skills & Abilities |

|45 |Under immediate supervision, utilizes PowerSuite (PS) to monitor claims work list & manage Self |Knowledge of: BWC & IC policies & standard operating procedures*;|

| |Insured (SI) caseload of medical/lost time disability; ensures claims documents are complete, |ORC rules & regulations*; applicable state & federal regulations |

| |accurate & in compliance with BWC procedures (e.g. C92 form signed by injured worker, motion |governing documents processed, reviewed &/or prepared*; public |

| |signed by physician,C9, DHO orders present, whether 26 weeks have lapsed from date of injury in |relations; BWC claims documents & forms*; SI*; IC*; CCT*; BWC |

| |Medical Only claim or date of last compensation in lost time claims); reviews incoming claims |claims-related terminology*. |

| |documents (e.g. motions, appeals, self-insured applications, C9s, C92/C92As) to determine |Skill in: operation of PC to efficiently log & enter data; PS*; |

| |required action (e.g. exam referral, schedule for hearing, additional condition) to ensure |use of general office equipment (e.g. telephone, fax machine). |

| |claims documents are forwarded to proper parties for action (e.g. Exam Scheduler, SI employer, |Ability to: solve practical, everyday problems, gather, collage &|

| |Industrial Commission [IC]); processes C92/C92A applications (e.g. mails applications received |classify information about practical, everyday problems, gather, |

| |to employers &/or reps, reviews applications & PS to ensure timely filing & that there are no |collate & classify information about data people or things; handle|

| |outstanding issues to prevent application from being processed); queries Injured Workers (IWs) |routine inquiries from & contacts with injured workers, employers,|

| |regarding possible other injuries within past 10 years & verifies 10-year history check form |legislators. |

| |(i.e. data provided by data warehouse system or C-123 form) is complete & types in missing | |

| |information (e.g. prior % permanent partial, all past claims, type of physician needed for exam,| |

| |county); requests medical documentation & wage information from (e.g. MCOs, SI Employers, IWs, | |

| |Employers) as appropriate; prepares exam packet by selecting forms on PS needed by the | |

| |physician; update PS on the status of exam (e.g. date scheduled for exam, date report received | |

| |by physician) & forward to appropriate contact for exam scheduling; generates Tentative Orders | |

| |on PS for all SI claims by entering required data into computer form (e.g. percentage of | |

| |permanent partial, additional conditions) & Right Faxes documents into fax queue; refers State | |

| |Fund claim to Customer Care Team (CCT) in cases where percentage of permanent partial was | |

| |identified in order to generate payment plans & Tentative Orders; reviews documentation & mail | |

| |(e.g. letters from SI employers, First Report of Injury [FROI] forms, returned employer | |

| |certification letters) for certification on initial & subsequent allowances & types information | |

| |into PS. | |

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|50 |Responds appropriately to customer inquiries (e.g. general claims inquiries) in person, via |Same as above plus Knowledge of: ODJFS cross match system*; |

| |phone, fax &/or e-mail (e.g. employers, IWs, legislators, providers) in regards to SI claims |TPAs*; MCOs*. |

| |processing; forwards calls of complicated nature & problematic issues (e.g. overpayments, | |

| |complex legal issues) to CCT for resolution; reviews claim histories & responds to general | |

| |questions & issues using PS, claims policy, law & rules; updates change of address requests | |

| |(e.g. C77) in PS Maintenance Window &/or communicates via e-mail &/or telephone to Benefits | |

| |Payable to ensure requests for Electronic Funds Transfers & Electronic Benefits Transfers are | |

| |processed timely for IW in order to ensure no interruptions in benefits; upon request of IWs | |

| |&/or employer representatives provides income verification letters & PS printouts (e.g. Social | |

| |Security, Housing Authority, Loans/Banks); enters general IW information (e.g. SS#, name) into | |

| |Ohio Department of Jobs & Family Services’ (ODJFS) cross match system & reports matches to CCT | |

| |which indicate that IW may have applied for, or received, benefits from ODJFS; enters authorized| |

| |representatives (e.g. IW representatives) in PS Maintenance Screen from data received on IWs | |

| |&/or employer representative cards (e.g. R2, R1); reviews IC hearing decisions & updates PS by | |

| |typing in new information; documents in PS Claims Notes actions & issues as appropriate (e.g. | |

| |notes to inform Workers’ Compensation Claims Specialist [CSS] that IW called & the CSS needs to | |

| |return the call, IW has been re-injured & requires follow-up by CSS or other CCT member); | |

| |photocopies & prints documents from claim files &/or PS upon request (e.g. subpoenas, print | |

| |requests from attorneys, third party administrators [TPAs], &/or MCOs); serves as backup for AE2| |

| |by accepting employer premium payments, processing of new applications and responding to basic | |

| |employer inquiries; submits records to Social Security website as requested. | |

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|5 |Performs other related duties as assigned (e.g. generates reports as requested by supervisor |Same as above plus |

| |&/or service office manager [e.g. weekly reports, status reports, trend-line reports], provides | |

| |work direction & moderate training for newly-hired claims assistants as assigned, accepts |(*) Developed after employment. |

| |payments for copies &/or updating payment transaction tracker). | |

| | |Position requires travel; therefore, persons occupying this |

| | |position must be able to provide own transportation &/or legally |

| | |operate a state-owned vehicle. |

| | | |

| | |THIS CLASSIFICATION MAY REQUIRE THE USE OF PROFICIENCY |

| | |DEMONSTRATION TO DETERMINE MINIMUM QUALIFICATIONS. |

|List Position Numbers & Job Titles of Positions Directly Supervised: |SIGNATURE OF AGENCY REPRESENTATIVE |DATE |

| | | |

| | |01/18/2019 |

ADM 4107 R 10-08 An Equal Opportunity Employer

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