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#LI-ISD