Medical Management Specialist

Erie Insurance Warrendale , PA 15086

Posted 4 months ago

Division or Field Office:

Pittsburgh Branch Office

Department of Position: Claims Department

Work from:

Pittsburgh Claims Office

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 5,000 employees and over 2,200 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. To attract and retain the best talent, we reward our team members with competitive salaries and a very generous benefits package.

Position Summary

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

Duties and Responsibilities

Handles first party medical benefit claims, including fatalities and self-employed 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 complex coverage questions according to applicable state law.

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.

Establishes immediate contact with Policyholders and Claimants. Contacts Agents as necessary.

Coordinates activities with the Home Office on serious or massive injury cases. Notifies company investigative services of cases involving suspected fraud.

Reviews claim files on a regular basis and takes necessary follow-up and/or closing action.

Assists defense counsel in trial preparation of litigated medical management claims.

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.

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.

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

Ability To Learn And Follow Procedures

Ability to Manage Complexity

Coaching

Decision Making

Detail Orientation

Developing And Maintaining Relationships

Influencing Skills

Information Management Skills

Interpersonal Communication

Job-Specific Knowledge

Oral Communication

Planning And Organizing

Problem Analysis

Service Orientation

Stress Tolerance

Time Management

Qualifications

Minimum Required Education Equivalents:

High School Diploma or GED and two years of related 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 33 and AIC 34 preferred. Working knowledge of medical bill repricing system preferred. Appropriate license as required by state.

Physical Requirements

Lifting 0-20 lbs; Occasional (< />

Lifting 20-50 lbs; Occasional (< />

Lifting Over 50 lbs; Occasional (< />

Driving; Rarely

Pushing/Pulling; Occasional (< />

Manual Keying/Data Entry; Often (20-50%)

Climbing; Rarely

Nearest Major Market: Pittsburgh

Job Segment: Law, Claims, Compliance, Legal, Insurance



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Medical Management Specialist

Erie Insurance