Workers Compensation Adjuster

Role Description

UPMC WorkPartners is hiring a full-time Workers Comp Lost Time Claims Specialist II! This role will predominantly work remotely, Monday - Friday daylight hours. The ideal candidate for this position holds a Pennsylvania Workers Comp Adjuster license.

The UPMC WorkPartners 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.
• Applying litigation management skills to manage litigation activities, budgets, and claim outcomes while considering the overall impact to the customer and company.
• Ensuring claims are processed within company policies, procedures, and within individual's prescribed authority.
• Possessing strategic thought process skills to effectively 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 manage the case resolution process and 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 to evaluate assigned claims to determine the extent of loss.
• Manage the litigation process through the retention of counsel, adhering to litigation guidelines.
• Communicate claim status with the injured worker, clients, and broker as needed.
• Effectively evaluate, negotiate, and resolve claims within delegated authority.
• Establish appropriate reserves and review regularly to ensure adequacy.
• Investigate claims through various means including telephone, written correspondence, and personal contact.
• Provide required reports to AVP, Claims, Underwriting, Reinsurance, and Actuarial on significant exposure cases.
• Obtain appropriate state licensing for assigned jurisdictions.
• Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types.
• Manage vendors and expenses effectively and efficiently.
• Participate in monthly account renewal meetings as needed.
• Mentor and train new employees as appropriately assigned by management.

Qualifications

• 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.
• Pennsylvania Workers Comp Insurance Adjusters license highly preferred.
• Experience with NJ, DE, and VA workers compensation are a bonus.
• 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 reserving and adjudication of Workers' compensation lost time claims.

Requirements

• Licensure, Certifications, and Clearances: Act 34.

Company Description

UPMC is an Equal Opportunity Employer/Disability/Veteran.