Job Description

Job Title: Lost Time Claims Specialist I
Job ID: 667049
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: WKP Comm WC Claims Admin
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:

UPMC Health Plan is hiring a full-time Lost Time Claims Specialist I to help support the Workers Compensation Commercial Claims Management Department for its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position.

 

 

The UPMC WorkPartners Workers' Compensation Lost Time Claims Specialist 1 reports to the Workers' Compensation Claims Supervisor. The Lost Time Claims Specialist 1 is responsible for coverage analysis, investigation, evaluation, negotiation and disposition of assigned claims for the WorkPartners Workers' Compensation business unit. The Lost Time Claims Specialist 1 will develop litigation management skills to aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. The Lost Time Claims Specialist 1 will also ensure claims are processed within company policies, procedures, and within individual's prescribed authority within established best practices and performance standards. The Lost Time Claims Specialist 1 should possess strategic thought process skills to effectively and efficiently manage loss exposures.

Responsibilities:

  • Actively participate in claim reviews with clients.
  • Appropriate state licensing to be obtained for assigned jurisdictions.
  • Assign medical or other experts to case and arrange for medical examinations when necessary.
  • Communicate claim status with the injured worker, clients, and broker as needed.
  • Develop lost time claim disposition skills under the direction of supervisor.
  • Effectively and efficiently manage vendors and expenses.
  • Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types.
  • Effectively evaluate, negotiate and resolve claims within delegated authority utilizing the appropriate denials or releases.
  • Ensure proper referrals and timely updates to appropriate Reinsurer(s) if applicable.
  • Establish appropriate reserves and review on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level.
  • Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, clients, witnesses and others having pertinent information.
  • Manage the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment.
  • Pro-actively manages the case resolution process. May participate in mediations within limit of settlement authority under supervision.
  • Provide required reports to AVP, Claims, Underwriting, Reinsurance and Actuarial on significant exposure cases.
  • Timely analyze information in order to evaluate assigned claims to determine the extent of loss.

Qualifications

  • Bachelors and/or advanced degree. (Minimum of 2-3 years of lost time claims experience will be considered in lieu of degree).
  • One year of workers compensation lost time claims handling experience or 18-24 months of workers compensation medical only claims handling experience.
  • Basic knowledge of law and insurance regulations in various jurisdictions.
  • Demonstrated strong verbal and written communications skills.
  • Demonstrated strong analytical and decision making skills.
  • Intermediate knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge.
  • Previous experience with the reserving and adjudication of the following: Workers compensation medical only claims
  • Workers compensation claim investigations and compensability decisions

    Licensure, Certifications, and Clearances:
    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $20.60 to $35.57

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



Now more than ever, YOU can help us shape our communities and UPMC into a better place for everyone to work, study, play, and thrive.

Learn more about working here and check out our policies and recent updates.

Share:
Talent Network