[Hiring] Lost Time Claims Specialist II @UPMC

Role Description

UPMC Health Plan and WorkPartners is hiring a full-time Lost Time Claims Specialist II to join the Workers Comp Claims team. This remote role will work business hours EST Monday - Friday and will primarily support Florida and Georgia claims.

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.
• Applying litigation management skills to manage litigation activities, budgets, and claim outcomes.
• Ensuring claims are processed within company policies, procedures, and established best practices.
• Possessing strategic thought process skills to effectively manage loss exposures.

Responsibilities include:

• Assigning medical or other experts to cases and arranging for medical examinations when necessary.
• Developing lost time claim disposition skills under limited direction of supervisor.
• Pro-actively managing the case resolution process and participating in mediations within limit of settlement authority.
• Ensuring proper referrals and timely updates to appropriate Reinsurer(s).
• Actively participating in claim reviews with clients.
• Timely analyzing information to evaluate assigned claims to determine the extent of loss.
• Managing the litigation process through the retention of counsel and adhering to litigation guidelines.
• Communicating claim status with the injured worker, clients, and broker as needed.
• Effectively evaluating, negotiating, and resolving claims within delegated authority.
• Establishing appropriate reserves and reviewing them regularly for adequacy.
• Investigating claims through various means including telephone, written correspondence, and personal contact.
• Providing required reports to AVP, Claims, Underwriting, Reinsurance, and Actuarial on significant exposure cases.
• Obtaining appropriate state licensing for assigned jurisdictions.
• Effectively evaluating and resolving coverage issues for all Workers' Compensation claim types.
• Managing vendors and expenses efficiently.
• Participating in monthly account renewal meetings as needed.
• Mentoring and training new employees as assigned by management.

Qualifications

• Bachelor’s 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.
• Florida and Georgia Workers Comp Adjusters license strongly preferred.
• Florida and Georgia lost time 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.
• Previous experience with the reserving and adjudication of Workers' compensation lost time claims.

Licensure, Certifications, and Clearances

• UPMC is an Equal Opportunity Employer/Disability/Veteran.