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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 required-typically once a month-at 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.

+ Bachelors and/or advanced degree OR a minimum of 2 years of administrative, claims, and/or customer service experience, preferably in Workers Compensation.

+ A minimum of 1 year of Workers Compensation medical only claim handling experience required

+ Demonstrated verbal and written communications skills.

+ Demonstrated analytical and decision making skills.

+ Appropriate state licensing to be secured as needed.

+ Excellent communication skills.Licensure, Certifications, and Clearances:UPMC is an Equal Opportunity Employer/Disability/Veteran