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Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

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.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

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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Medical Only Claims Specialist I

  • Job ID: 876631580
  • 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: $20 to $33.22 / hour

Description

The UPMC WorkPartners Workers' Compensation Medical Only Claims Specialist 1 reports to the Workers' Compensation Supervisor. This is an entry-level position within the Workers' Compensation Claims Department. The Medical Only Claims Specialist 1 is responsible for coverage analysis, investigation, evaluation, communication, and disposition of assigned medical claims within the WorkPartners Workers' Compensation business unit. The Medical Only Claims Specialist 1 will ensure claims are processed within company policies, procedures, and within individual's prescribed authority following established best practices and performance standards.

This position is historically work-from-home. 

Hiring team preferences:

  • Strong verbal and written communication skills; strong decision-making skills. 
  • Professional approachable.
  • Basic knowledge of claims handling concepts, practices, techniques, coverage issues and product line knowledge


Responsibilities:

  • Manage non-complex and non-problematic medical-only and restricted medical only, claims under close supervision.
  • Additional duties as required.Appropriate state licensing to be secured as needed.Excellent communication skills.
  • Adhere to client and carrier guidelines and special handling requests.
  • Communicate claim status with the injured worker, insured/employer, and broker as needed.
  • Prepare and present for insured/employer claim reviews outlining claims status and action plans with oversight from supervisor
  • Receives claim, confirms policy coverage and acknowledgement of the claim
  • Evaluate claim, calculate and establish appropriate reserves and review on a regular basis to ensure adequacy for exposure under close supervision.
  • Establish reserves and authorize payments within authority limits.
  • Investigate the claims through telephone, written correspondence, and/or personal contact with injured workers, insureds/employer witnesses and others having pertinent information.
  • Review invoices and medical records to determine eligibility for payment or denial.
  • Determine validity and compensability of the claim.

 

Qualifications

  • Bachelor's and/or advanced degree (One year of Property & Casualty claims handling experience, preferably in Workers' Compensation, will be considered in lieu of degree)
  • Demonstrated verbal and written communications skills.
  • Demonstrated analytical and decision-making skills.
  • Appropriate state licensing to be secured as needed.
  • Excellent communication skills.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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