Remote Lost Time Claims Specialist II - Workers' Comp

UPMC; Pittsburgh (Allegheny County); Remote; USD 70,000 - 95,000; Full time

Job summary

UPMC Health Plan and WorkPartners is hiring a full-time Lost Time Claims Specialist II to join the Workers Comp Claims team. This remote role will support Virginia, Maryland, Pennsylvania, and Washington, DC claims during EST business hours, Monday through Friday.

The ideal candidate has experience managing lost time claims in Virginia and Maryland; Pennsylvania and Washington, DC experience is a bonus. The role emphasizes coverage analysis, investigation, evaluation, negotiation and disposition

Qualifications

• Bachelor’s degree or higher, or a minimum of 3 years of Workers’ Compensation claims handling experience.
• Minimum 2 years of Workers’ Compensation lost time claims handling experience.
• Maryland and Virginia lost time claims experience strongly preferred; PA/DC a bonus.
• Intermediate knowledge of law and insurance regulations.
• Strong verbal and written communication skills.
• Act 34 licensure or certification required/preferred.

Responsibilities

• Assign medical or other experts to cases and arrange examinations when necessary.
• Develop lost time claim disposition skills under limited supervision.
• Proactively manage case resolution; participate in mediations within settlement authority.
• Ensure referrals and timely updates to reinsurer(s).
• Participate in claim reviews with clients.
• Analyze information to evaluate claims and determine loss extent.
• Manage litigation with counsel; adhere to guidelines including budgets and bills.
• Communicate claim status with injured workers, clients, and brokers.
• Evaluate and resolve claims within delegated authority using denials or releases.
• Establish reserves and review regularly to ensure adequacy.
• Investigate claims via telephone, correspondence, or site visits.
• Provide required reports to AVP, Claims, Underwriting, Reinsurance and Actuarial.
• Obtain appropriate state licensing for assigned jurisdictions.
• Evaluate and resolve coverage issues for Workers’ Compensation claims.
• Manage vendors and expenses effectively.
• Participate in monthly account renewal meetings; mentor and train staff.

Skills

Communication

Analytical skills

Claims handling

Litigation management

Budget management

Education

Bachelor's degree

Job description

UPMC Health Plan and WorkPartners is hiring a full-time Lost Time Claims Specialist II to join the Workers Comp Claims team. This remote role will support Virginia, Maryland, Pennsylvania, and Washington, DC claims during EST business hours, Monday through Friday.

The ideal candidate has experience managing lost time claims in Virginia and Maryland; Pennsylvania and Washington, DC experience is a bonus. The role emphasizes coverage analysis, investigation, evaluation, negotiation and disposition