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Lost Time Claims Specialist II

  • Job ID: 637993171
  • 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' rockstar Workers Compensation team is seeking a Lost Time Claims Specialist II!
The UPMC WorkPartners Workers Compensation Lost Time Claims Specialist 2 reports to the Workers Compensation Claims Supervisor. The Lost Time Claims Specialist 2 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 2 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 2 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 2 should possess strategic thought process skills to effectively and efficiently manage loss exposures.

This position can be in the office OR full-time remote and would ideally work 7:00 am – 3:30 pm. 

Up for the challenge? Apply today!

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. (Minimum of 3-5 years of claims experience will be considered in lieu of degree)
  • Minimum of 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, to include 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

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   Current UPMC employees must apply in HR Direct