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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