Cincinnati - BWC Fraud Analyst PN: 20066747 at Ohio Department of Administrative Services

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Full Time

Start Date

Immediate

Expiry Date

06 Feb, 26

Salary

0.0

Posted On

08 Nov, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Investigation, Communication, Analytical Skills, Report Writing, Fraud Detection, Claims Management, Customer Service, Data Analysis, Medical Documentation, Problem Solving, Decision Making, Public Relations, Interviewing Techniques, Mathematics, Surveillance Equipment, Computer Proficiency

Industry

Government Administration

Description

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 click this link to read more, and then come back to this job posting to submit your application! What You’ll Be Doing: Acting as the lead worker for the investigative team to develop investigative action plans; prioritizing cases, maintaining case progression, and ensuring proper investigative steps and safety concerns are being addressed. Reviewing/critiquing reports of investigation completed by investigative staff & ensuring accuracy, completeness & thoroughness; determining if fraud has been established & when applicable, writing clear, concise & professional correspondence & reports; monitoring investigative cases throughout the appeals process & informing appropriate entities of the outcome. Communicating both verbally and in writing, to effectively & professionally collaborate with coworkers, injured workers, employers, legislators, health care providers & public. Using the Fraud Management System (FMS), Universal Document System (UDS), Microsoft Excel and other SID programs to effectively analyze cases utilizing analytical charting (e.g., flow charts & link analysis). Conducting thorough claim reviews in CoreSuite to gather information & evaluate the appropriateness of medical treatment &/or disability payments; monitoring and documenting claims activities; researching and interpreting medical documentation & terminology from medical providers, preparing BWC orders or IC motion(s) requesting specific actions based on investigation results; adjusting benefit plans, declaring overpayment allocations, stopping improper medical payments; issuing recoupment correspondence; preparing recovery packets; calculating, inputting and adjusting overpayment & actuarial savings totals. 54 mos. exp. in private insurance organization as claims representative, criminal investigator, rehabilitation case manager or equivalent position; 6 mos. exp. in operation of personal computer; valid driver’s license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment. -Or completion of undergraduate core coursework in business, criminal justice, humanities, social & behavioral science, education or related field; 18 mos. exp. in insurance organization as claims representative, criminal investigator, rehabilitation case manager or equivalent position; 6 mos. exp. in operation of personal computer; valid driver’s license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment . -Or 18 mos. exp. as Workers' Compensation Claims Specialist, 16722, or managing caseload of workers' compensation lost-time disability claims which involved making decision to allow or deny claim, verifying appropriateness of medical treatment & charges, pre-authorized medical treatment, equipment, supplies & special travel arrangements, researching, negotiating, authorizing & issuing settlement of claims &/or conducting field inquiries to accurately assess claim information & resolving disputed condensability & benefit level for Ohio Bureau Of Workers' Compensation; 6 mos. exp. in operation of personal computer; valid driver’s license. The final applicant accepted for this position must successfully pass state highway patrol personal background check prior to employment. -Or 18 mos. exp. as BWC Fraud Investigator, 26261. Note: Pursuant to Ohio Administrative Code Chapter 4501 users of system shall adhere to policies & guidelines published in NCIC operating manual, CJIS security policy, LEADS operating manual, LEADS security policy, newsletters, & administrative messages from LEADS, all of which are either available on ODPS/LEADS intranet or disseminated to LEADS agencies; pursuant to LEADS security policy (revised 05/07/03) state & national fingerprint-based record checks must be conducted within 30 days of initial employment or assignment of all personnel, including appropriate IT personnel, having access to LEADS, or to records storage areas containing CCH/II data; minimum check must include submission of both a State of Ohio BCI& I card & an FBI applicant fingerprint card; both completed applicant fingerprint cards must be submitted by employing agency to State of Ohio Bureau of Criminal Identification & Investigation for processing & forwarding to Federal Bureau of Investigation; record of this check must be kept by employing agency & made available to LEADS upon request; fingerprint card returned by Ohio BCI&I is sufficient documentation. Pursuant to Ohio Administrative Code Chapter 4501 terminal agency shall conduct a complete background investigation of all terminal operators including, but not limited to: an applicant fingerprint card submission to BCI&I & FBI, an inquiry of state & national arrest & fugitive files; terminal agency is required to notify CTO of any applicant’s criminal record; existence of a criminal record may result in denial of access. Job Skills: Investigation Major Worker Characteristics: Knowledge of Business, Criminal Justice, Humanities, Social & Behavioral Science Education or related field; BWC Policies & Procedures*, Laws & Regulations related to Adjudication & Maintenance of Workers’ Compensation Claims*; Agency, State &/or Federal Statutes, rules, regulations & procedures applicable to investigation, evidence gathering & search & seizure*; English; oral & written communication; Public relations; interviewing techniques; principles of customer service; fundamental math operations; standard business practices. Skill in use of personal computer; word processor*; data base & spreadsheet software*; analytical software used in Fraud Detection*; surveillance equipment (e.g., 35 mm camera; camcorder; mini camera; undercover audio recording devices)* Ability to communicate effectively & professionally with injured workers, employers, legislators, health care providers & public; make complex decisions regarding claims activity; read & understand medical reference manuals; write clear, concise & professional correspondence & reports; collate & classify information about data, people or things; assess immediate situation & make split second decisions; respond to sensitive inquiries from & contacts with injured workers, employers, legislators, health care providers & public. (*) Developed after employment.

Responsibilities

Lead the investigative team to develop action plans and ensure proper investigative steps are taken. Review investigation reports for accuracy and communicate findings effectively with various stakeholders.