Medical Management Specialist
About The Position
Within designated authority, handles medical management claims with limited supervision. This is an onsite position at ERIE Insurance’s Allentown Branch Office and is not a work-from-home role. The successful candidate should have experience with personal injury protection. The position handles first-party medical benefit claims, including fatalities and wage loss claims. It involves evaluating coverage, investigating and valuing claims, setting and maintaining reserves, managing cases, preparing correspondence and reports, obtaining medical and employment records, calculating wage loss under applicable state laws, and bringing claims to resolution. The specialist also reviews claim-related bills and medical, rehabilitation, and investigative reports, and determines whether claims should be paid, compromised, or contested. The role coordinates serious or massive injury cases with the Home Office, refers suspected fraud to investigative services, and may manage claims in litigation while working with legal counsel on case strategy. Additional duties include attending industry training, assisting or acting for the supervisor when needed, identifying subrogation opportunities, developing expertise in legal and medical procedures, assisting with staff training, and managing vendors cost-effectively. Regular and predictable attendance is an essential job function.
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.
- The successful candidate should have experience with personal injury protection.
- 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 fatality and wage loss claims; evaluate coverage, investigate and value claims, 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 serious or massive injury cases with the Home Office and notify company investigative services about cases involving suspected fraud.
- When appropriate, manage claims in litigation and assist legal counsel with case strategy.
- Attend industry-related training to stay current on legal developments and comply with applicable laws and regulations.
- Assist or act on behalf of the supervisor when required, including handling insurance department complaints.
- Identify subrogation situations when appropriate and initiate appropriate action.
- Develop expertise in legal and medical terminology and procedures.
- Assist in training branch office personnel in related matters.
- Assign, monitor, and control vendor activities in a cost-effective manner.
- Maintain regular and predictable attendance.
Benefits
- Premier health, prescription, dental, and vision benefits for employees and dependents, with coverage beginning on 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, in addition to the pension.
- 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
