Claims Examiner Workers Compensation

Claims Examiner Workers Comp I

UPMC Health Plan and Work Partners is hiring a full-time Claims Examiner Workers Comp I to join the Commercial Worker Comp Claims Admin team. This role will predominantly work remotely but will require in office presence in downtown Pittsburgh's US Steel Tower monthly and as needed for meetings.

This role is responsible for setting up workers' compensation claims within 24 hours of receipt and ensuring employee confidentiality. This role supports operational goals through clerical and technical tasks and helps maintain strong client relationships. Duties include daily claim reviews, managing incoming provider calls, participating in team meetings, and performs tasks in accordance with claim management standards, compliance requirements, and as assigned by leadership.

Responsibilities:

• Set up Workers' Compensation claims received from the clients within a 24-hour period.
• Maintain employee confidentiality and privacy.
• Maintain excellent relationship with clients.
• Participate in team meetings and provide ideas, suggestions, and feedback to promote effective program management.
• Perform job duties and responsibilities in accordance to Work Partners Claims Management Standards.
• Perform other duties as assigned by the supervisor and/or manager.
• Provide clerical and technical support to the team to achieve operational goals.
• Maintain the Daily Claim Review and Daily All Claim Validation reports.
• Perform Payment/Error Validation – process for check validation and production.
• Maintain the No Claim on File (NCOF) queue.
• Complete daily Diary requests.
• Perform claim indexing.

High School Graduate

Minimum 6 months clerical, claims or customer service experience.

Computer proficiency strongly preferred.

Proficiency in Microsoft Excel strongly preferred.

Proficiency in typing required.

Good written (grammar and punctuation) and verbal communication skills including the ability to communicate clearly and being a good listener via the telephone.

Customer Service oriented.

Organization skills.

Detail oriented.

Licensure, Certifications, and Clearances:

Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran