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Claims Adjuster

2 months ago

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

We are seeking a skilled Claims Adjuster to join our team at Erie Insurance. As a 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
  • Minimum Required Education Equivalents: High School Diploma or GED and two years of general claims handling experience required, or Bachelor's Degree 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.
Competencies
  • Values Diversity
  • Job-Specific Knowledge
  • Self-Development
  • Nimble Learning
  • Collaborates
  • Customer Focus
  • Cultivates Innovation
  • Optimizes Work Processes
  • Instills Trust
  • Ensures Accountability
  • Decision Quality