UPMC – Medical Only Claims Specialist I (Remote) – Pittsburgh, PA

September 21, 2022

Job Description



Job title: Medical Only Claims Specialist I (Remote)

Company: UPMC


Job description: Description

UPMC and Workpartners has an exciting opportunity for a Medical Only Claims Specialist I. This is a Monday through Friday daylight role (regular, full-time) with remote work arrangements.

The UPMC WorkPartners Workers’ Compensation Medical Only Claims Specialist 1 reports to the Workers’ Compensation Supervisor. This is an entry level position within the Workers’ Compensation Claims Department. The Medical Only Claims Specialist 1 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 1 will ensure claims are processed within company policies, procedures, and within individual’s prescribed authority following established best practices and performance standards.

Responsibilities:

  • Manage non-complex and non-problematic medical-only and restricted medical only, claims under close supervision.
  • Additional duties as required.
  • Appropriate state licensing to be secured as needed.
  • Excellent communication skills.
  • Adhere to client and carrier guidelines and special handling requests.
  • Communicate claim status with the injured worker, insured/employer, and broker as needed.
  • Prepare and present for insured/employer claim reviews outlining claims status and action plans with oversight from supervisor
  • Receives claim, confirms policy coverage and acknowledgement of the claim
  • Evaluate claim, calculate and establish appropriate reserves and review on a regular basis to ensure adequacy for exposure under close supervision.
  • Establish reserves and authorize payments within authority limits.
  • Investigate the claims through telephone, written correspondence, and/or personal contact with injured workers, insureds/employer witnesses and others having pertinent information.
  • Review invoices and medical records to determine eligibility for payment or denial.
  • Determine validity and compensability of the claim.
  • Participate in periodic claim reviews as needed.
  • Participate in monthly account renewal meetings as needed.

Qualifications

  • Bachelor’s and/or advanced degree or a minimum of 1 year of administrative, claims, and/or customer service experience, preferably in Workers’ Compensation. Administrative and claims experience strongly preferred.
  • 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

Total Rewards

More than just competitive pay and benefits, package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

Current UPMC employees must apply in


Expected salary: $20 – 33.22 per hour

Location: Pittsburgh, PA

Job date: Wed, 21 Sep 2022 04:14:16 GMT



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