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Job Description - Cleveland - BWC Fraud Analyst - PN: 20066666 (260006FV)

Cleveland - BWC Fraud Analyst - PN: 20066666 (260006FV)

Organization

Workers' Compensation

Work Location

Cleveland Service Office 615 West Superior Avenue Cleveland 44113-1889

Primary Location

United States of America-OHIO-Cuyahoga County-Cleveland

Compensation: $34.53 - $50.66

Schedule

Full-time

Work Hours: 40

Union: OCSEA

Primary Job Skill

Technical Skills: Investigation

Professional Skills: Attention to Detail, Ethics and Values, Reasoning, Teamwork, Written Communication

Agency Overview

A Little About Us:
With roughly 1,500 employees in seven 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 strives to maintain an inclusive workplace. We begin by being an equal opportunity employer. Employees can participate in and lead employee work groups, participate in on-line forums 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.

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 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.

What You’ll Be Doing

• Works under direction of Special Investigations Supervisors & primarily conducts internal & external record searches and/or review and cross reference of data to identify red flags for further investigation.
• Collaborates with the BWC Intelligence Unit to develop new data sets to analyze, collate, and mine for data anomalies and trends for further investigation.
• Generate allegations and investigative leads for the BWC special Investigation teams by utilizing the Fraud Management System (FMS), CORESuite, Internet, IBM Cognos, Tableau, Microsoft Excel as well as develop data from external sources, Criminal Justice data bases & other systems to effectively facilitate detection & investigation support.
• Acts as a lead worker establishing criteria to detect fraudulent activity & initiate investigations into allegations of fraud, abuse, & assist with development of detection ideas.
• Identifies behavioral trends &/or performs outlier analyses for stratified data populations; using computer technologies & advanced analysis techniques to design databases, compile & analyze large data sets in order to assist team in investigations of fraudulent schemes.

Why Work for the State of Ohio

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*. For a list of all the State of Ohio Benefits, visit our Total Rewards website ! Our benefits package includes:

• Medical Coverage
• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
• Public Retirement Systems ( such as OPERS, STRS, SERS, and HPRS ) &Optional Deferred Compensation ( Ohio Deferred Compensation )

*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

Qualifications

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; 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.
-Or 18 mos. exp. as BWC Fraud Investigator, 26261. Note: ...

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 & 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. Requires some knowledge of disability insurance claims policies & procedures.

Skill in

use of personal computer; word processor*; database & spreadsheet software*; statistical analysis, data visualization & analytical software used in Fraud Detection*.

Ability to

define problems, collect data, establish facts & draw valid conclusions; gather, collate & classify information about data, people or things; prepare meaningful, concise & accurate reports; 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 & members of general public.

(*) Developed after employment.

EEO & ADA Statement

The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.

The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox BWCADA@bwc.ohio.gov .

BWC OCSEA Selection Rights

This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.

Transportation

Position may require travel; therefore, persons occupying this position must be able to provide own transportation &/or legally operate a state-owned vehicle.

Educational Transcripts

For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.

Background Check

Prior to an offer of employment , the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.

ADA Statement

Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

Drug-Free Workplace

The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.