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Workers' Compensation Adjuster II

Date: May 7, 2022

Location: Silver Spring, MD, US, 20904

Company: Erie Insurance

Division or Field Office:

Claims Division

Department of Position: Corporate Claims Department 

Work from:

Home, within ERIE footprint

 

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 the ERIE footprint
  • The Hiring Manager will also consider candidates for Workers' Compensation Adjuster I.  Level of position offered will be based upon the depth and breadth of selected candidate's experience and qualifications

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

Duties and Responsibilities

Handles workers’ compensation claims, including fatalities and possible complex claims.  Investigates and determines compensability and evaluates and makes recommendations regarding coverage of claims.  Conducts field investigations as necessary, determines total value of claims, including anticipated time off and settlement exposure,  establishes and maintains adequate reserves, manages cases and prepares related correspondence and reports.   Maintains all records and related materials. Reviews claims files on a regular basis and takes necessary follow-up and/or closing action.  

 

Establishes immediate 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, telephone calls and legal documents in litigated claims. Determines claims to be paid, compromised or contested.

 

Coordinates activities with rehabilitation specialist on seriously injured claimants and refers special risk situations to commercial underwriting. Notifies company investigative services of cases involving suspected fraud.

 

Negotiates settlements with petitioner's counsel, referring to defense counsel when appropriate. Works in partnership with defense counsel in formulating plan of action in litigated claims. Attends hearings and mediations as required.

 

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 impacting the operation of the department.

 

Assists or acts on behalf of the Worker's Compensation Claims Supervisor when required.  

Competencies

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

Qualifications

High School diploma or GED required.  Bachelor’s degree preferred.

 

Five years of previous workers’ compensation claims handling experience, including a strong working knowledge of applicable state laws required.  Strong working  knowledge of medical bill processing required.  Successful completion of AIC37, AIC44 and medical interpretation courses preferred. Experience with Maryland claims preferred.

 

Willingness to obtain and maintain any required licenses.  Valid driver’s license required.

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: Washington DC