Medical Management Specialist (Personal Injury Protection)

Division or Field Office Casualty Claims Division Department of Position Medical Management Department Work From the Rochester, NY, Erie, Pittsburgh or Allentown Branch Office Salary Range $52,843.00 - $84,410.00* 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 (State) based on ERIE's geographical differences, 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. Position Summary Within designated authority, handles medical management claims with limited supervision. This role is being reposted adding language about the skills required. If you have applied, you will NOT need to reapply, your application is under consideration. Multiple positions are available. The successful candidate should have experience with personal injury protection. The successful candidate will work from one of the following branches: Rochester, NY, Erie, Pittsburgh or Allentown Branch office. Duties and 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. 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 the behalf of 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. Capabilities Values Diversity Job-Specific Knowledge Self-Development Nimble Learning Collaborates Customer Focus Cultivates Innovation Optimizes Work Processes (IC) 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 #J-18808-Ljbffr