Medical Only Claims Specialist II - Pittsburgh

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