Workers Compensation Specialist

Division or Field Office:

Claims Division

Department of Position: Workers' Compensation Dept 

Work from:

Home in ERIE's Footprint  Salary Range:

$43,190.00 - $68,992.00 *

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.

 

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 medical only claims.

 

• This is a remote position, successful candidate will work from home and live within ERIE’s Footprint (District of Columbia, Illinois, Indiana, Kentucky, Maryland, North Carolina, Ohio, Pennsylvania, Tennessee, Virginia, West Virginia, Wisconsin)
• The successful candidate will handle medical claims primarily for West Virginia but would also be expected to serve as a backup for Virginia, Maryland, and the District of Columbia.
• Candidates residing in West Virginia are required to obtain an adjuster’s license within 90 days of hire.

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.

Duties and Responsibilities (cont'd if applicable)

The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished.

This position description in no way states or implies that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instruction and to perform any other duties as requested by their supervisor, or as become clear.

Capabilities

• 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

Minimum Educational Requirements

• High School diploma or equivalent, required.

 

Designations and/or Licenses 

• Successful completion of Introduction to Insurance, Introduction to Claims (AIC30) and medical interpretation course preferred.
• Appropriate license as required by state.

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

Apply