Description

UPMC Workpartners is seeking a Disability Specialist. 
The Disability Specialist will provide accurate claims adjudication and superior customer service to all of UPMC and WorkPartners customers.

This role is completely remote.

Responsibilities:

• Independently manages STD caseload within current process and procedures. Utilizes Clinical nurse Case Manager and/or Medical Director resources within established guidelines
• Analyzes claims and determines benefits due on claims in accordance to the ERISA regulations and policy provisions.
• Provide thorough claim management that includes timely notification and follow-up, thorough employee understanding, accurate documentation and appropriate referrals.
• Participate in training activities to keep skill set updated.
• Authorizes timely claim payments upon receipt of appropriate medical information.
• Calculates and assigns accurate benefit calculations to each claim and monitors benefit payments.
• Investigates claims and determines eligibility for Short-Term Disability benefits.
• Utilizes Clinical nurse Case Manager and/or Medical Director resources within established guidelines.
• Interact with physicians, medical providers, claimants and employers either in writing or by telephone.
• Support partnership with vocational team to ensure proactive claims management plans are set and established return to work and Stay at Work (SAW) processes are followed
• Maintains excellent communications with employees, employers, human resources and disability team.

Qualifications

• High school graduate required
  • College degree and/or professional certifications preferred
• A minimum of 3 years of disability claims management experience
• Skills include: Excellent organizational and time management skills.
• Excellent written and verbal communication skills including the ability to communicate clearly by telephone and/or in writing.
• Working knowledge of Microsoft office products including Microsoft Outlook.
• Strong knowledge of Short-Term Disability to ensure solid and consistent claims determinations.
• Strong medical knowledge

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.