Senior Workers' Compensation Adjuster Job at Erie Insurance
Division or Field Office:
Claims Division
Work from:
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.
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.
- A 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.
- A 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension.
- 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.
For New York City Residents Only: The salary range for New York City residents is $90,274- $139,976. Starting rate of pay varies and is based on multiple factors, including but not limited to, position offered, location, education, work experience, certifications, etc. For information regarding our benefits programs, please visit: https://www.erieinsurance.com/careers/benefits
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.
- This is a remote, work from home position.
- The ideal candidate can live anywhere in the Erie Footprint.
- This job will be handling Worker's Compensation claims for North Carolina, Kentucky and Tennessee.
Duties and Responsibilities
Handles complex workers’ compensation 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 apropriate. Works in partnership with defense counsel in formulating plan of action in litigated claims. Attends hearings and mediations as required.
Participates in informational 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 Regional Worker's Compensation Complex Claim Manager when required.
Competencies
Qualifications
High School diploma or GED required. Bachelor’s degree preferred.
Six 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 pursue WCLA course modules related to workers’ compensation required.
Willingness to obtain and maintain any required licenses. Valid driver’s license required.
Physical Requirements
Nearest Major Market: Charlotte
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