Workers Compensation Specialist

Erie Insurance-posted about 1 year ago
$43,190 - $68,992/Yr
Full-time • Entry Level
Remote • Erie, PA
5,001-10,000 employees
Insurance Carriers and Related Activities
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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.

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