Workers Compensation Specialist - Erie Insurance

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

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

• Successful candidate will work from home and reside within Erie's footprint.

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 (
Lifting 20-50 lbs; Occasional (
Lifting Over 50 lbs; Occasional (
Driving; Rarely

Pushing/Pulling; Occasional (
Manual Keying/Data Entry; Often (20-50%)

Climbing; Rarely

Nearest Major Market: Nashville