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.

• This is a remote position, the successful candidate will work from home and live within ERIE’s Footprint.
• The successful candidate will handle medical only claims which could include the following jurisdictions, NC,IN,TN,KY,IL,WI,SC,MO,GA.
• A state adjusters license is strongly recommended.

CAPABILITIES

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

MINIMUM EDUCATIONAL REQUIREMENTS

• High School diploma or equivalent, required.

PHYSICAL REQUIREMENTS

• Lifting/Moving 0-20 lbs; Occasional (<20%)
• Lifting/Moving 20-50 lbs; Occasional (<20%)
• Ability to move over 50 lbs using lifting aide equipment; Occasional (<20%)
• Driving; Rarely
• Pushing/Pulling/moving objects, equipment with wheels; Occasional (<20%)
• Manual Keying/Data Entry/inputting information/computer use; Often (20-50%)
• Climbing/accessing heights; Rarely
  Nearest Major Market: Eri

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.

salary range is for this level 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

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, the successful candidate will work from home and live within ERIE’s Footprint.
• The successful candidate will handle medical only claims which could include the following jurisdictions, NC,IN,TN,KY,IL,WI,SC,MO,GA.
• A state adjusters license is strongly recommended