Lost Time Claims Specialist III (Remote, New Jersey/Pennsylvania)

UPMC's Health Plan is hiring a Lost Time Claims Specialist III for its Workers' Compensation Claims Admin Team.

This is a remote position and may require travel to Pittsburgh for meetings. The position is Monday through Friday 7am-3:30pm, 7:30am-4pm, 8am-4:30pm or 8:30am-5pm.

This position will need New Jersey and Pennsylvania claims adjuster experience.

The UPMC Workpartners Workers' Compensation Lost Time Claims Specialist 3 reports to the Workers? Compensation Claims Supervisor. The Lost Time Claims Specialist 3 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 3 will aggressively manage litigation activities, budgets and claim outcomes while considering the overall impact to the customer and company. The Lost Time Claims Specialist 3 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 3 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 appropriate level for claims outside of authority level.
• Develop Lost Time claim disposition skills under minimal supervision.
• Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types.
• Communicate claim status with the injured worker, clients, and broker as needed.
• Actively participate in claim reviews with clients.
• Timely analyze information in order to evaluate assigned claims to determine the extent of loss.
• Appropriate state licensing to be obtained for assigned jurisdictions.
• Effectively evaluate, negotiate and resolve claims within delegated authority utilizing the appropriate denials or releases.
• Pro-actively manages the case resolution process. May participate in mediations within limit of settlement authority.
• Effectively and efficiently manage vendors and expenses.
• Manage the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment.
• 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.
• Assign medical or other experts to case and arrange for medical examinations when necessary.
• Ensure proper referrals and timely updates to appropriate Reinsurer(s).
• Participate in monthly account renewal meetings as needed.
• Mentoring and training new employees as appropriately assigned by management.
• Participate in monthly account renewal meetings as needed.
• Mentoring and training new employees as appropriately assigned by management.

• Bachelor's and/or advanced degree or a minimum of 5 years of Workers' Compensation claims handling experience.
• Minimum of 3 years of Workers' Compensation Lost Time Claims handling experience.
• Strong knowledge of law and insurance regulations in various jurisdictions.
• Demonstrated strong verbal and written communications skills.
• Demonstrated strong analytical and decision making skills.
• Strong 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.

Preferences:

• Strong preference for New Jersey and Pennsylvania Claims adjuster experience
• Strong preference for proficiency with Microsoft Office and general computer skills

Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran