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Workers Compensation Specialist

Date: Jun 23, 2022

Location: Millcreek, PA, US, 16505

Company: Erie Insurance

Division or Field Office:

Claims Division

Department of Position: Corporate Claims Department 

Work from:

Home within ERIE's footprint (PA, NY, OH, IL, IN, WI, TN, KY, MD/DC, VA, NC, WV)

 

At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 5,000 employees and over 2,200 independent agencies.  Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia.  To attract and retain the best talent, we reward our team members with competitive salaries and a very generous benefits package.

 

Position Summary

  • This is a remote position working from home within ERIE's footprint (PA, NY, OH, IL, WI, TN, KY, MD/DC, VA, NC, WV)
  • This position will handle claims for Illinois and Wisconsin, with potential for growth.

 

Responsible for handling Worker’s Compensation claims within designated authority, exercising discretion and independent judgement in the decision-making process on medical only claims.

Duties and 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 imediate contact with policyholders, claimants and medical providers.  Contacts Agents as necessary. 

 

Evaluates and resolves coverage questions, exercising discretion and independent judgement and 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, compromised.

 

Refers claim 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 cost-effective manner.

 

Attends industry-related training programs to stay current on legal developments and ensure compliance with applicable laws and regulations impacting the operation of the department.

Competencies

Values Diversity
Nimble Learning
Self-Development
Collaborates
Information Management Skills
Customer Focus
Cultivates Innovation
Job-Specific Knowledge
Optimizes Work Processes
Instills Trust
Ensures Accountability
Decision Quality

Qualifications

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.

Physical Requirements

Lifting 0-20 lbs; Occasional (<20%)
Lifting 20-50 lbs; Occasional (<20%)
Lifting Over 50 lbs; Occasional (<20%)
Driving; Rarely
Pushing/Pulling; Occasional (<20%)
Manual Keying/Data Entry; Often (20-50%)
Climbing; Rarely


Nearest Major Market: Erie