Workers' Compensation Adjuster II

Erie Insurance in; Erie (Erie County); Remote; USD 69,000 - 111,000; Full time

Job summary

Join a forward-thinking company as a Workers' Compensation Adjuster II, where you will manage and investigate claims while working from home. This role offers the opportunity to make a significant impact on the lives of injured workers by ensuring fair compensation and providing support throughout the claims process. With a commitment to employee development and a comprehensive benefits package, this position is perfect for those seeking to grow in a dynamic and inclusive environment. If you have a passion for helping others and a strong background in claims handling, this is the role for you!

Benefits

Premier health, prescription, dental, and vision benefits

401(k) with up to 4% contribution match

Paid time off including vacation and parental leave

Tuition reimbursement program for higher education

Traditional pension plan

Company-paid life insurance

Short- and long-term disability insurance

Paid volunteer hours

Matching charitable gifts

Qualifications

• Five years of experience in handling workers' compensation claims.
• Strong knowledge of applicable state laws and medical bill processing.

Responsibilities

• Handles and investigates workers' compensation claims and determines compensability.
• Establishes contact with policyholders, claimants, and medical providers.

Skills

Workers' Compensation Claims Handling

Medical Bill Processing

Detail Orientation

Decision Quality

Customer Focus

Education

High School Diploma or GED

Bachelor's Degree

Job description

Workers' Compensation Adjuster II (Finance)

Division or Field Office:

Claims Division
Department of Position: Workers' Comp & Med Mgmt Dept
Work from:
Home in ERIE's Footprint Salary Range:
$69,318.00-$110,729.00*

salary range is for thislevel 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're not just part of a Fortune 500 company; you're 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:

• 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.

Position Summary

Responsible for handling Worker's Compensation claims within designated authority, exercising discretion and independent judgement in the decision-making process on all claims assigned.

• This is a remote, work from home position.
• Successful candidate ideally will live in PA but can reside anywhere in ERIE's Footprint.
• PA Adjuster experience is strongly preferred.
• Will also consider Workers' Compensation Adjuster I.

Duties and Responsibilities

• Handles workers' compensation claims, including fatalities and possible complex claims. Investigates and determines compensability and evaluates and makes recommendations regarding coverage of claims. Conducts field investigations as necessary, determines total value of claims, including anticipated time off and settlement exposure, establishes and maintains adequate reserves, manages cases and prepares related correspondence and reports. Maintains all records and related materials. Reviews claims files on a regular basis and takes necessary follow-up and/or closing action.
• Establishes immediate contact with policyholders, claimants and medical providers. Contacts agents as necessary.
• Evaluates and resolves coverage questions, exercising discretion and independent judgement and in compliance with applicable workers compensation law.
• Receives, processes and takes appropriate action on claim-related communications, including bills, medical reports, specialist investigative reports, telephone calls and legal documents in litigated claims. Determines claims to be paid, compromised or contested.
• Coordinates activities with rehabilitation specialist on seriously injured claimants and refers special risk situations to commercial underwriting.Notifies company investigative services of cases involving suspected fraud.
• Negotiates settlements with petitioner's counsel, referring to defense counsel when appropriate. Works in partnership with defense counsel in formulating plan of action in litigated claims. Attends hearings and mediations as required.
• Participates in informal presentations to Agents and Policyholders.
• Assigns, monitors, and controls activities of vendors in a cost-effective manner.
• 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 Worker's Compensation Claims Supervisor when required.

Capabilities

• Self-Development
• Detail Orientation
• Collaborates
• Cultivates Innovation
• Instills Trust
• Information Management Skills
• Decision Quality
• Values Diversity
• Job-Specific Knowledge
• Nimble Learning
• Customer Focus
• Optimizes Work Processes (IC)
• Ensures Accountability

Qualifications

Minimum Educational Requirements

• High School diploma or GED required.
• Bachelor's degree preferred.

Additional Experience

• Five years of previous workers' compensation claims handling experience, including a strong working knowledge of applicable state laws required.
• Strong working knowledge of medical bill processing required.

Designations and/or Licenses

• Successful completion of AIC37, AIC44 and medical interpretation courses preferred.
• Willingness to obtain and maintain any required licenses.
• Valid driver's license required.

Physical Requirements

• Lifting/Moving 0-20 lbs; Occasional (<20>
• Lifting/Moving 20-50 lbs; Occasional (<20>
• Ability to move over 50 lbs using lifting aide equipment; Occasional (<20>
• Driving; Rarely
• Pushing/Pulling/moving objects, equipment with wheels; Occasional (<20>
• Manual Keying/Data Entry/inputting information/computer use; Often (20-50%)
• Climbing/accessing heights; Rarely

Nearest Major Market: Erie