Workers' Compensation Adjuster II - Erie Insurance

Division or Field Office:

Claims Division
Department of Position: Corporate Claims Department
Work from:
Home in TN or KY Salary Range:
$67,958.00-$108,556.00*

salary range is for thislevel and may vary based on actual level of role hired for

*This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location, and experience of an applicant, as well as level of role for which the successful candidate is hired.Position may be eligible for an annual bonus payment.

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 6,000 employees and over 13,000 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.

Benefits That Go Beyond The Basics

We strive to be Above all in Service® to our customers-and to our employees. That's why Erie Insurance offers you an exceptional benefits package, including:

• Premier health, prescription, dental, and vision benefits for you and your dependents.Coverage begins your first day of work.
• Low contributions to medical and prescription premiums.We currently pay up to 97% of employees' monthly premium costs.
• Pension.We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full-time employees are vested after five years of service.
• 401(k) with up to 4% contribution match.The 401(k) is offered in addition to the pension.
• Paid time off.Paid vacation, personal days, sick days, bereavement days and parental leave.
• Career development.Including a tuition reimbursement program for higher education and industry designations.

Additional benefits that include 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 service to your community; and dollar-for-dollar matching of your charitable gifts each year.

Position Summary

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

• The successful candidate will work from home and must live in ERIE's Footprint.
• This position will handle KY and TN claims. It is preferred to have a Tennessee Certification. (If you do not have a certification, you would need to successfully complete the certification at the next available certification class)
• Kentucky workers' compensation license preferred (or successfully obtain your Kentucky license within 90 days of hire).
• The Hiring Manager will also consider candidates for a Workers Compensation Adjuster I. Level of position offered will be based upon the depth and breadth of selected candidate's experience and qualifications.

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.

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

Physical Requirements

Lifting/Moving 0-20 lbs; Occasional (
Lifting/Moving 20-50 lbs; Occasional (
Ability to move over 50 lbs using lifting aide equipment; Occasional (
Driving; Rarely

Pushing/Pulling/moving objects, equipment with wheels; Occasional (
Manual Keying/Data Entry/inputting information/computer use; Often (20-50%)

Climbing/accessing heights; Rarely

Nearest Major Market: Knoxville