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New York PIP Claims Adjuster
2 months ago
New York Branch Office
Department of Position: Claims Department
Work from:
NY Claims office
Salary Range:
$50, $81,131.00 *
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 are not just part of a Fortune 500 company; you are 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:
- Comprehensive health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work.
- Minimal 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.
Position Summary
Within designated authority, manages medical management claims with limited supervision.
- This is an in-office position.
- The ideal candidate will reside within a reasonable driving distance from the NY Claims Office.
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 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.
Duties and Responsibilities (cont'd if applicable)
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 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 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 Required Education Equivalents:
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.
Physical Requirements
Lifting/Moving 0-20 lbs; Occasional (
