Workers' Compensation Specialist II
Location: Pittsburgh, Pennsylvania
Description: UPMC is employing Workers' Compensation Specialist II right now, this vacancy will be reside in Pennsylvania. For detail informations about this vacancy opportunity kindly see the descriptions. UPMC Health Plan is hiring a full-time Workers Compensation Specialist II to help support the day to day operations of the Commercial Workers' Compensation Claims Administration Depart! ment for its downtown Pittsburgh location. The position will be working standard business hours, and will require flexibility as needed.
The Workers Compensation Specialist II will investigate and analyze facts surrounding a work related event. Upon concluding the investigation, this role will determine independently whether the claim for benefits should be accepted or denied. Once a claim for benefits is accepted, manage claims involving medical conditions that lead to complicated long-term medical only claims, claims involving restricted duty limitations, claims disability from work as a result of significant medical or surgery, claims in litigation for review, suspension, termination and settlement of benefits.
Responsibilities
- Assist in medical conditions that would cause a claim to result in restricted duty, work loss or surgical intervention.
- Manage claims in which treatment may require specialist referral or second opinion! .
- Handle claims involving restricted duty from work t! hat may or may not lead to wage loss.
- Manage claims involving lost time.
- Issue Bureau of Workers' Compensation documentation.
- Manage claims in which claimant is represented by an attorney.
- Manage claims involving litigation activities.
- Assist in settlements negotiations within limits.
- Conduct initial investigation to determine eligibility (3-point contact) within 24 hours of receiving notice of claim.
- Investigate who, what, when, where, why, and how the accident occurred and prepare concise written investigation notes.
- Prepare documentation of claim activity which is factual, clear, and detailed capturing activity and plan of action.
- Address the potential for subrogation and notify parties at the time of investigation or as soon as there is an indication of 3rd party involvement.
- Send FROI to the Bureau of Workers' Compensation promptly upon day, shift or turn being missed by injured e! mployee.
- Upon completion of investigation, conduct factual analysis and make independent determination whether to deny or accept claim in accordance with Pennsylvania Workers'
- Compensation laws and regulations.
- Calculate wage loss benefit rate based on pre-injury earnings.
- Evaluate and determine independently monetary reserves to be assigned to cover the potential exposure of claim.
- Document rationale for reserve changes.
- Make timely claim payments. (Medical claims typically to be paid within 30 days and first time wage loss to be paid within 21 days and every two weeks thereafter.)
- Complete and issue appropriate Bureau of Workers' Compensation document (acceptance or denial) within 21 days of first day of disability.
- Complete and issue appropriate closing document(s), and obtain signature of claimant if necessary within two weeks.
- Complete diaries timely and follow pertinent activities on the ! claim.
- Capture work loss and restricted days.
- Engage ! litigation indicator and complete litigation fields when legal activity is underway.
- Send LIBC-760 form to claimant for completion and return every six months.
- Conduct follow-up to determine allowable offset.
- Follow-up within 24 hours of a claimant's physician's appointment for the results of appointment.
- Prepare notes to reflect the status of medical appointments to include work restrictions, anticipated period of disability, and net follow-up appointment.
- Review claim for OSHA record keeping.
- Notify Human Resource Department of claimant's lost time from work.
- Coordinate transfer of claims file and interact with Short Term Disability unit when a Workers' Compensation Claim is denied.
- Report and continually update Claims to excess carrier(s).
- Prepare notes for litigation and all other vendor activities in a clear, concise and factual manner.
- Address and implement promptly all action pl! ans and supervisory recommendations.
- Maintain a high level of quality customer service.
- Prepare and present factual details of claim and future plan of action during claim review with clients.
- High school diploma.
- College degree, professional certifications, and licenses preferred.
- Three years Workers' Compensation claims management experience.
- Knowledge of basic Workers' Compensation management.
- Good clerical, organizational and typing skills.
- Experience with computer software packages.
- Good English language skills (grammar, punctuation).
- Good interpersonal and customer service skills.
- Good written and verbal communication skills, including ability to communicate clearly by telephone.
- Attention to detail.
18.51
25.13
31.75
UPMC is an equal opportunity employer.
- .
If you were eligible to this vacancy, please give us your! resume, with salary requirements and a resume to UPMC.
Interested on this vacancy, just click on the Apply button, you will be redirected to the official website
This vacancy will be opened on: Tue, 24 Sep 2013 19:33:39 GMT
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