Disability Claims Examiner (Benefits Management Representative)
State of Ohio - Columbus, OH

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Job Duties:
The Ohio Department of Administrative Services, Human Resources Division is seeking an experienced human resources professional for the position of Benefits Customer Service Representative to work as part of a team of professionals that provide support in processing disability claims for state employees.

Responsibilities include, but are not limited to:
Processes and approves/disapproves disability claims based on established policies & procedures.
Communicates with employees, agency representatives, medical providers and third party administrators to process disability claims.
Provides technical assistance to state workers and state agencies to resolve issues related to disability leave benefits.
Coordinates and case manages disability benefit claims and return to work process of basic to moderate complexity. Analyzes medical information to facilitate the case management process.
Acts as liaison between Benefits Administration Services, state agencies and state employees on disability claims issues.
Conducts research, resolves complaints and provides assistance and information to hearing representatives and represents management in appeals of disability claims.
Makes recommendations to improve processing and claims management.
To view copy of the full position descriptions, please click on the below links:

http://apps.das.ohio.gov/EmpSrv/Upload/20005956%20BMR-PD%20HRD%2007.27.10.pdf http://apps.das.ohio.gov/EmpSrv/Upload/20005960%20BMR-PD%20HRD%2007.27.10.pdf

Minimum Qualifications:
24 mos. exp. in adjudicating benefit claims or in coordinating benefit claims issues with third party administrators &/or insurers in governmental agency or private sector; 12 mos. exp. in public relations; 3 mos. exp. in operation of video display terminal or personal computer. -Or equivalent of Minimum Class Qualifications for Employment noted above.

Major Worker Characteristics:
Knowledge of assigned benefit program area (e.g., state life &/or health &/or dental &/or vision insurance programs; workers' compensation; occupational injury leave; disability leave; early intervention & return to work programs & initiatives; case management programs; unemployment benefits); applicable Ohio revised code sections; departmental procedures & federal benefits laws governing assigned benefit areas (e.g., eligibility criteria; claims processing; condition & cost of coverage; diseases & disabling condition & medical terminology); public relations; interviewing*. Skill in operation of word processing equipment or personal computer. Ability to understand & interpret insurance contracts; write procedural memos & directives regarding program & procedures for assigned area; deal with some abstract but mostly concrete variables; handle sensitive inquiries from & contact with officials & general public; use proper research methods in gathering data; prepare & deliver speeches before specialized audiences; resolve complaints from personnel officers & agency representatives; answer inquiries from employees, industry officials & payroll/personnel officers. (*)Developed after employment.

Supplemental Information:
POSITION SPECIFIC MINIMUM QUALIFICATIONS:
  • Two years experience in Case Management
  • Two years experience in medical terminology and ICD-9 codes.
  • Two years experience in Return to Work programs.
Preferred Experience:
Two years experience adjudicating disability claims

All applications must clearly indicate how the Minimum Qualifications & Position Specific Minimum Qualifications, if applicable, are met. Applications that do not indicate this, will not be given consideration.

  • IMPORTANT NOTE: Please do not include your Social Security Number (SSN) with your on-line application and/or documentation. If attaching a document that contains your SSN, please redact (black out) SSN before attaching it to your application.
The State of Ohio is an Equal Opportunity Employer and provider of ADA services.

When contacted for an interview, an applicant who requires special accommodations due to a disability should notify the office at the time he/she is contacted so that proper arrangements can be made for the interview.

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