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UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

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Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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Lost Time Claims Specialist I (Remote)

  • Job ID: 529420928
  • 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
  • Union Position: No
  • Salary Range: $22.56 to $38.96 / hour

Description

UPMC Workpartners is hiring a Workers' Compensation Lost Time Claims Specialist I to join the team!


The UPMC Workpartners Workers' Compensation Lost Time Claims Specialist I reports to the Workers' Compensation Claims Supervisor. The Lost Time Claims Specialist I 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 I 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 I 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 I should possess strategic thought process skills to effectively and efficiently manage loss exposures.

Responsibilities:

 

  • Establish appropriate reserves and review on a regular basis to ensure adequacy. Make recommendations to set reserves at an appropriate level for claims outside of authority level.
  • Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types.
  • 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.
  • Appropriate state licensing to be obtained for assigned jurisdictions.
  • Actively participate in claim reviews with clients.
  • Effectively and efficiently manage vendors and expenses.
  • Assign medical or other experts to cases and arrange for medical examinations when necessary.
  • Timely analyze information in order to evaluate assigned claims to determine the extent of loss.
  • Communicate claim status with the injured worker, clients, and broker as needed.
  • 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.
  • 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.
  • Develop lost time claim disposition skills under the direction of supervisor.

This is a work-from-home position.

 

Qualifications

  • Bachelor's and/or advanced degree or a minimum of 2 years of Workers' Compensation claims handling experience.
  • A minimum of 1 year of Workers' Compensation lost time claims handling experience or 18 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, including but not limited to coverage issues, and product line knowledge.
  • Previous experience with the reserving and adjudication of Workers' compensation medical only claims Workers' compensation claim investigations and compensability decisions.
  • Previous office experience preferred.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct

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