Medical Management Specialist

Erie Insurance • Town of Henrietta, NY

14d • Onsite

About The Position

Within designated authority, handles medical management claims with limited supervision.

This position is based out of our New York Branch Claims office in Rochester, NY.

Requirements

• High School Diploma or GED and two years of general claims handling experience required, or;
• Bachelor’s Degree required.
• OR completion of formal ERIE training program, required.

Nice To Haves

• Strong working knowledge of applicable state laws preferred.
• Good working knowledge of human anatomy and medical terminology preferred.
• Expertise in state no-fault laws and working knowledge of civil law preferred.
• Working knowledge of medical bill repricing system preferred.
• Successful completion of AIC courses preferred.
• Appropriate license as required by state.

Responsibilities

• Handles first party medical benefit claims, including fatalities and wage loss claims. Evaluates and makes decisions regarding coverage. Conducts investigations, determines total value of claims, sets and maintains adequate reserves, and manages cases.
• Prepares related correspondence and reports, obtains medical and employment related records, calculates wage loss claims per applicable state laws and brings claims to conclusion.
• Investigates, evaluates, and resolves coverage questions in compliance with applicable state laws.
• Establishes immediate contact with Policyholders and Claimants. Contacts Agents as necessary.
• Reviews claim files on a regular basis and takes necessary follow-up and/or closing action.
• Evaluates, processes and takes appropriate action on claim-related bills and medical, rehabilitation and special investigative reports. Determines claims to be paid, compromised or contested.
• Coordinates activities with the Home Office on serious or massive injury cases. Notifies company investigative services of cases involving suspected fraud.
• When appropriate manages claims in litigation and assist in the development of case strategy with legal counsel.
• Attends industry-related training programs to stay current on legal developments and ensure compliance with applicable laws and regulations impacting the operation of the department.
• Assists or acts on the behalf of supervisor when required, including handling of insurance department complaints.
• When appropriate identifies subrogation situations and initiates appropriate action.
• Develops expertise in legal and medical terminology and procedures.
• Assists in training branch office personnel in related matters.
• Assigns, monitors and controls activities of vendors in a cost-effective manner.

Benefits

• Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work.
• Low contributions to medical and prescription premiums. We currently pay up to 97% of employees’ monthly premium costs.
• Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service.
• 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension.
• Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave.
• Career development. Including a tuition reimbursement program for higher education and industry designations.
• Additional benefits that include company-paid basic life insurance; short-and long-term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well-being programs; paid volunteer hours for service to your community; and dollar-for-dollar matching of your charitable gifts each year.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED