Medical Only Claims Specialist II - Pittsburgh

Medical Only Claims Specialist II

UPMC WorkPartners is hiring a full-time Medical Only Claims Specialist II to join the Workers Comp Claims team. This role follows a standard Monday through Friday schedule during daylight hours. The position is primarily remote, with occasional in-office presence requiredtypically once a monthat the U.S. Steel Tower. Candidates should reside locally in the Pittsburgh area.

The UPMC WorkPartners Workers' Compensation Medical Only Claims Specialist 2 reports to the Workers' Compensation Supervisor. This is an intermediate level position within the Workers' Compensation Claims Department. The Medical Only Claims Specialist 2 is responsible for coverage analysis, investigation, evaluation, communication, and disposition of assigned medical claims within the WorkPartners Workers' Compensation business unit. The Medical Only Claims Specialist 2 will ensure claims are processed within company policies, procedures, and within individual's prescribed authority following established best practices and performance standards.

Responsibilities :

• Establish appropriate reserves and review on a regular basis to ensure adequacy under supervision as necessary.
• Determine validity and compensability of the claim independently.
• Manage non-complex and non-problematic medical-only, restricted medical only, and limited lost time claims under some supervision.
• Minor negotiations of claims for compromise and release
• Investigate the claims through telephone, written correspondence, and / or personal contact with injured workers, insureds, witnesses and others having pertinent information.
• Communicate claim status with the injured worker, insured, and broker as needed.
• Adhere to client and carrier guidelines and participate in claims review as needed.
• Receives claim, confirms policy coverage and acknowledgement of the claim
• Establish reserves and authorize payments within authority limits.
• Assists other claims professionals with more complex or problematic claims as necessary, which could include periodic handling of litigated cases
• Participate in periodic claim reviews as needed.
• Appropriate state licensing to be secured as needed.
• Mentoring and training new employees as appropriately assigned by management.
• Participate in monthly account renewal meetings as needed.

Qualifications :