At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic continues to evolve. As our recruiters work to fill positions during this time, interviews and recruitment-related processes have been modified to protect and prioritize the safety of our candidates and employees.

UPMC continues to comply with any governmental guidance related to local, state, and federal COVID-19 vaccination and testing requirements where our team members live and work. UPMC strongly supports vaccination and encourages everyone who can get vaccinated to do so to protect themselves, their co-workers, and our patients. At this time, the COVID-19 vaccination is available for new or existing employees on a voluntary basis, except where required by local, state, or federal authorities. Staff in positions in our New York, Maryland, and City of Philadelphia areas must be in compliance with local COVID-19 mandates.

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

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Lost Time Claims Specialist II

  • Job ID: 342030579
  • 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: $24.05 to $41.60 / hour

Description

UPMC WorkPartners Workers Compensation department is seeking a Lost Time Claims Specialist II.

The UPMC WorkPartners Workers Compensation Lost Time Claims Specialist II reports to the Workers Compensation Claims Supervisor. The Lost Time Claims Specialist II 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 II will apply 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 II 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 II should possess strategic thought process skills to effectively and efficiently manage loss exposures.

This position is in the US Steel Tower (600 Grant St. Pittsburgh, PA 15219) Hours: 7:00 am – 3:30 pm. 

Responsibilities:

  • Assign medical or other experts to case and arrange for medical examinations when necessary.
  • Develop lost time claim disposition skills under limited direction of supervisor.
  • Pro-actively manages the case resolution process. May participate in mediations within limit of settlement authority.
  • Ensure proper referrals and timely updates to appropriate Reinsurer(s).
  • Actively participate in claim reviews with clients.
  • Timely analyze information in order to evaluate assigned claims to determine the extent of loss.
  • Manage the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment under limited direction of supervisor.
  • 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.
  • 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.
  • Provide required reports to AVP, Claims, Underwriting, Reinsurance and Actuarial on significant exposure cases.
  • Appropriate state licensing to be obtained for assigned jurisdictions.
  • Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types.
  • Effectively and efficiently manage vendors and expenses.

 

Qualifications

  • Bachelors' and/or advanced degree.
  • A minimum of three to five (3-5) years of claims experience will be considered in lieu of degree
  • Minimum of two (2) years of workers' compensation lost-time claims handling experience.
  • Intermediate 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, litigation management, and product line knowledge.
  • Previous experience with the reserving and adjudication of the following: Workers' compensation lost time claimsWorkers' compensation claim investigations (including subrogation) and compensability decisions


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct