Workers Comp Lost Time Claims Specialist II

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

Responsibilities:

• Assign medical or other experts to cases 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 of communication with claimants, attorneys, clients, and others.
• 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 efficiently.
• Participate in monthly account renewal meetings as needed.
• Mentor and train new employees as 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.
• 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.
• Previous experience with reserving and adjudication of Workers' compensation lost time claims.

Licensure, Certifications, and Clearances

• Appropriate state licensing to be obtained for assigned jurisdictions.

Company Description

UPMC is an Equal Opportunity Employer/Disability/Veteran.