Medical Management Specialist (Personal Injury Protection)

Erie Insurance•Marshall Township, PA

4d•$50,327 - $80,392•Onsite

About The Position

Within designated authority, handles medical management claims with limited supervision. This position is based at the Pittsburgh Branch Office in Warrendale, Pennsylvania and is not work from home. The role handles first-party medical benefit claims, including fatalities and wage loss claims, and evaluates coverage, investigates and values claims, establishes and maintains reserves, and manages cases through resolution. It also involves reviewing and acting on claim-related bills and medical, rehabilitation, and investigative reports; coordinating with internal teams, legal counsel, vendors, and other parties; and keeping current on legal developments and applicable regulations.

Requirements

High school diploma or GED and two years of general claims handling experience, or a bachelor's degree, or completion of a formal ERIE training program.
Appropriate license as required by the state.
Regular and predictable attendance.

Nice To Haves

Strong working knowledge of applicable state laws.
Good working knowledge of human anatomy and medical terminology.
Expertise in state no-fault laws and working knowledge of civil law.
Working knowledge of a medical bill repricing system.
Successful completion of AIC courses.

Responsibilities

Handle first-party medical benefit claims, including fatalities and wage loss claims; evaluate coverage; investigate claims; determine claim value; set and maintain reserves; and manage cases.
Prepare correspondence and reports; obtain medical and employment records; calculate wage loss claims under applicable state laws; and bring claims to conclusion.
Investigate, evaluate, and resolve coverage questions in compliance with applicable state laws.
Establish immediate contact with policyholders and claimants and contact agents as necessary.
Review claim files regularly and take necessary follow-up or closing action.
Evaluate and process claim-related bills and medical, rehabilitation, and special investigative reports; determine whether claims should be paid, compromised, or contested.
Coordinate with the Home Office on serious or massive injury cases and notify company investigative services of suspected fraud cases.
When appropriate, manage litigated claims and assist legal counsel in developing case strategy.
Attend industry-related training to stay current on legal developments and ensure compliance with applicable laws and regulations.
Assist or act on behalf of the supervisor when required, including handling insurance department complaints.
Identify potential subrogation situations and initiate appropriate action when applicable.
Develop expertise in legal and medical terminology and procedures.
Assist in training branch office personnel on related matters.
Assign, monitor, and control vendor activities cost-effectively.
Maintain regular and predictable attendance.

Benefits

Premier health, prescription, dental, and vision benefits for employees and dependents, with coverage beginning the first day of work.
Low employee contributions to medical and prescription premiums; the company currently pays up to 97% of employees’ monthly premium costs.
Traditional pension plan; full-time employees are vested after five years of service.
401(k) with up to 4% contribution match.
Paid vacation, personal days, sick days, bereavement days, and parental leave.
Tuition reimbursement for higher education and industry designations.
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 community service.
Dollar-for-dollar matching of charitable gifts each year.
Position may be eligible for an annual bonus payment.