Workers Compensation Specialist

Erie Insurance • Erie, PA

301d • $43,190 - $68,992 • Remote

About The Position

The position is responsible for handling Worker's Compensation claims within designated authority, exercising discretion and independent judgement in the decision-making process on medical only claims. This is a remote position, and the successful candidate will work from home while living within ERIE's Footprint, which includes the District of Columbia, Illinois, Indiana, Kentucky, Maryland, North Carolina, Ohio, Pennsylvania, Tennessee, Virginia, West Virginia, and Wisconsin. The successful candidate will primarily handle medical claims for West Virginia but will also serve as a backup for Virginia, Maryland, and the District of Columbia. Candidates residing in West Virginia are required to obtain an adjuster's license within 90 days of hire.

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.

Responsibilities

• Handles medical only workers' compensation claims.
• Investigates and determines compensability, checks coverage, establishes and maintains reserves, handles related correspondence and reports, and maintains records.
• Reviews claim files on a regular basis and takes 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 judgement in compliance with applicable workers' compensation law.
• Receives, processes, and takes appropriate action on claim-related communications, including bills, medical reports, specialist investigative reports, and telephone calls.
• Determines claims to be paid or compromised and refers claims to WC Adjuster when nurse case management appears appropriate and 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 and ensure compliance with applicable laws and regulations.

Benefits

• Premier health, prescription, dental, and vision benefits for you and your dependents, with coverage beginning your first day of work.
• Low contributions to medical and prescription premiums, with the company paying up to 97% of employees' monthly premium costs.
• Traditional pension plan, with full-time employees vested after five years of service.
• 401(k) with up to 4% contribution match, offered in addition to the pension.
• Paid time off including vacation, personal days, sick days, bereavement days, and parental leave.
• Career development opportunities including a tuition reimbursement program 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, and 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