Medical Claims Adjuster

2 weeks ago


Rochester, New York, United States Erie Insurance Full time
Job Summary

We are seeking a highly skilled Medical Claims Adjuster to join our team at Erie Insurance. As a Medical Claims Adjuster, you will be responsible for handling medical management claims with limited supervision.

Key Responsibilities
  • Handles first-party medical benefit claims, including fatalities and wage loss claims.
  • Evaluates and makes decisions regarding coverage.
  • Conducts investigations, determines total value of claims, sets and maintains adequate reserves, and manages cases.
  • Prepares related correspondence and reports, obtains medical and employment-related records, calculates wage loss claims per applicable state laws, and brings claims to conclusion.
  • Investigates, evaluates, and resolves coverage questions in compliance with applicable state laws.
  • Establishes immediate contact with policyholders and claimants. Contacts agents as necessary.
  • Reviews claim files on a regular basis and takes necessary follow-up and/or closing action.
  • Evaluates, processes, and takes appropriate action on claim-related bills and medical, rehabilitation, and special investigative reports.
  • Determines claims to be paid, compromised, or contested.
  • Coordinates activities with the Home Office on serious or massive injury cases. Notifies company investigative services of cases involving suspected fraud.
  • When appropriate, manages claims in litigation and assists in the development of case strategy with legal counsel.
Requirements
  • High School Diploma or GED and two years of general claims handling experience required, or;
  • Bachelor's Degree required.
  • OR completion of formal ERIE training program, required.
  • Strong working knowledge of applicable state laws preferred.
  • Good working knowledge of human anatomy and medical terminology preferred.
  • Expertise in state no-fault laws and working knowledge of civil law preferred.
  • Successful completion of AIC courses preferred.
  • Working knowledge of medical bill repricing system preferred.
  • Appropriate license as required by state.
What We Offer

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.


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