Workers Comp Lost Time Claims Specialist II - PA & NJ Claims

UPMC • Pittsburgh, PA • 4h ago

UPMC Health Plan and WorkPartners is hiring a full-time Lost Time Claims Specialist II to join the Workers Comp Claims team. This role will work Monday - Friday daylight hours EST and may work remotely. Preference will be given to those with prior PA or NJ claims experience.

The 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.

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.

Participate in monthly account renewal meetings as needed.

Mentoring and training new employees as appropriately assigned by management.

Bachelors and/or advanced degree or a minimum of 3 years of Workers Compensation claims handling experience.

Minimum of 2 years of Workers Compensation lost time claims handling experience.

PA and NJ claims experience strongly preferred.

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 claims, Workers' compensation claim investigations (including subrogation) and compensability decisions. Licensure, Certifications, and Clearances:UPMC is an Equal Opportunity Employer/Disability/Veteran

UPMC

Go to Apply

Share this job

Similar Jobs

Tax Senior, Global Trade - Classification

Deloitte • Pittsburgh, PA • 4h ago

Finance, Accounting & Banking

Do you enjoy providing powerful business solutions to some of the world's most well-known and respected companies, including more than 75 percent of the Fortune 100? Would you like to join one of the leading professional...

4h ago

Go to Apply

bank teller

FARMERS NATIONAL BANK OF CANFIELD • Cranberry Township, PA • 9h ago

Finance, Accounting & Banking

Description SUMMARY: Processes a variety of customer transactions at a teller window. Recognizes customer needs and recommends products, services, or assistance of other bank employees or departments, to consistently del...

9h ago

Go to Apply

Mortgage Collection Representative

First National Bank • Pittsburgh, PA • 9h ago

Finance, Accounting & Banking

Primary Office Location: 626 Washington Place. Pittsburgh, Pennsylvania. 15219. Join our team. Make a difference - for us and for your future. Position Title: Mortgage Collection Representative 1 Business Unit: Mortgage...

9h ago

Go to Apply

Title Claims Prevention Coordinator- Operations - 3887

Pitt Ohio Express, LLC. • Cheswick, PA • 10h ago

Finance, Accounting & Banking

PITT OHIO Express LLC US-PA-Cheswick ID: 2026-3887 Category: Administrative Assistant Position Type: Full-Time Remote: No Overview PITT OHIO is a family-owned transportation company with a long-standing commitment to saf...

10h ago

Go to Apply

Bookkeeper/Accounting

Personnel Staffers Inc. • Mcmurray, PA • 11h ago

Finance, Accounting & Banking

Bookkeeper/Accounting - CPA firm in McMurray has immediate need for staff member to perform various accounting and tax responsibilities. Flexible hours preferably Monday through Friday 10:00 AM to 4:00 PM. $22.00 per hou...

11h ago

Go to Apply

Accounting Admin - Acrisure Stadium / Concessions

ARAMARK • Pittsburgh, PA • 16h ago

Finance, Accounting & Banking

Job Description The Administrative Support Worker is responsible for assisting management with administrative tasks including, but not limited to, ordering, data entry, filing, etc. The Administrative Support Worker will...

16h ago

Go to Apply

accountant iii

Aqua America, Inc • Pittsburgh, PA • 16h ago

Finance, Accounting & Banking

Essential Utilities, Inc. delivers safe, clean, reliable services that improve quality of life for individuals, families, and entire communities. Operating as the Aqua (water and wastewater services) and the Peoples and...

16h ago

Go to Apply

Insurance Sales Agent

The Stiger Agency, Inc • Canonsburg, PA • 16h ago

Finance, Accounting & Banking

Join Our Team - Property & Casualty Insurance Sales Agent Are you a motivated, customer-focused professional looking for a rewarding career with unlimited earning potential? We are seeking a licensed Property & C...

16h ago

Go to Apply

Assoc Corporate Financial Systems Analyst

FEDEX CORPORATION AND SUBS 12 • Pittsburgh, PA • 1d ago

Finance, Accounting & Banking

Under close supervision, provides support in the development of enterprise-wide back office financial systems, including but not limited to systems supporting: human resources, finance, payroll, accounting and reporting....

1d ago

Go to Apply

SAP Finance - Cost Center Accounting - Manager Consultant - Location Open

EY • Pittsburgh, PA • 1d ago

Finance, Accounting & Banking

Location: Anywhere in Country At EY, we're all in to shape your future with confidence. We'll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY...

1d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)