Healthcare Claims Management Expert

2 weeks ago

Hagerstown, Maryland, United States Erie Insurance Full time
Division or Field Office:

Hagerstown Claims Office
Department of Position: Claims Department
Work from:
Hagerstown or Silver Spring Office Salary Range:
$48,371.00-$77,269.00*

This salary range is for this level and may vary based on the 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 the level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment.

At Erie Insurance, you are part of a Fortune 500 company and a valued member of a diverse and inclusive team comprising over 6,000 employees and more than 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.

Comprehensive Benefits Package

We aim to excel in service to our customers and employees. That’s why Erie Insurance provides 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 cover 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. Includes 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 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 community service; and dollar-for-dollar matching of your charitable contributions each year.

Position Overview

Within designated authority, manages medical management claims with limited supervision.

The selected candidate will reside in Hagerstown, Silver Spring, or the surrounding area and will work in-office.

Key Responsibilities
  • Processes 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 regularly 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.
Additional Responsibilities
  • 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 supervisor when required, including handling of insurance department complaints.
  • When appropriate, identifies subrogation situations and initiates appropriate action.
  • Develops expertise in legal and medical terminology and procedures.
  • Assists in training branch office personnel in related matters.
  • Assigns, monitors, and controls activities of vendors in a cost-effective manner.
The first five duties listed are essential functions of the job. Essential functions are those job duties that must be performed to accomplish the job.

This position description does not imply that these are the only duties to be performed by the incumbent. Employees are required to follow any other job-related instructions and perform any other duties as requested by their supervisor or as become evident.

Competencies

Values Diversity

Job-Specific Knowledge

Self-Development

Nimble Learning

Collaborates

Customer Focus

Cultivates Innovation

Optimizes Work Processes

Instills Trust

Ensures Accountability

Decision Quality

Qualifications

Minimum Educational 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.
Additional Experience
  • 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.
  • Working knowledge of medical bill repricing system preferred.
Designations and/or Licenses
  • Successful completion of AIC courses preferred.
  • Appropriate license as required by state.
Physical Requirements

Lifting/Moving 0-20 lbs; Occasional (
Lifting/Moving 20-50 lbs; Occasional (
Ability to move over 50 lbs using lifting aide equipment; Occasional (
Driving; Rarely

Pushing/Pulling/moving objects, equipment with wheels; Occasional (
Manual Keying/Data Entry/inputting information/computer use; Often (20-50%)

Climbing/accessing heights; Rarely

Nearest Major Market: Hagerstown

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