Workers Compensation Specialist

Erie Insurance • Erie, PA

398d • $43,190 - $68,992 • Remote

About The Position

The position is responsible for handling Worker's Compensation claims within designated authority, focusing on medical-only claims. The role requires exercising discretion and independent judgment in the decision-making process, ensuring compliance with applicable laws and regulations. This is a remote position, allowing employees to work from home within the ERIE operating footprint, specifically handling claims within Pennsylvania.

Requirements

• High School diploma or equivalent required.
• Successful completion of Introduction to Insurance, Introduction to Claims (AIC30), and medical interpretation course preferred.
• Appropriate license as required by state.

Nice To Haves

• Experience in handling workers' compensation claims.
• Knowledge of applicable workers' compensation laws and regulations.

Responsibilities

• Handles medical only workers' compensation claims.
• Investigates and determines compensability, checks coverage, establishes and maintains reserves, and handles related correspondence and reports.
• Maintains records and reviews claim files regularly, taking necessary follow-up and/or closing action.
• Establishes immediate contact with policyholders, claimants, and medical providers, and contacts agents as necessary.
• Evaluates and resolves coverage questions, exercising discretion and independent judgment in compliance with applicable workers' compensation law.
• Receives, processes, and takes appropriate action on claim-related communications, including bills, medical reports, and specialist investigative reports.
• Determines claims to be paid or compromised and refers claims to WC Adjuster when nurse case management appears appropriate or in cases of suspected fraud.
• Participates in informal presentations to agents and policyholders.
• Assigns, monitors, and controls activities of vendors in a cost-effective manner.
• Attends industry-related training programs to stay current on legal developments.

Benefits

• Premier health, prescription, dental, and vision benefits for employees and dependents, starting from the first day of work.
• Low contributions to medical and prescription premiums, with the company covering up to 97% of monthly premium costs.
• Traditional pension plan with vesting after five years of service.
• 401(k) plan with up to 4% contribution match.
• Paid time off including vacation, personal days, sick days, bereavement days, and parental leave.
• Tuition reimbursement program for higher education and industry designations.
• Company-paid basic life insurance and short- and long-term disability insurance.
• Adoption assistance and fertility coverage.
• Well-being programs and paid volunteer hours for community service.
• Dollar-for-dollar matching of charitable gifts.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees