Workers' Compensation Adjuster I

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.

• The successful candidate will work from home and must live in ERIE’s footprint.
• The Hiring Manager will also consider candidates for Workers’ Compensation Adjuster II. Level of position offered will be based upon the depth and breadth of selected candidate’s experience and qualifications.
• The successful candidate will handle NY Workers’ Compensation Claims
• There are 2 open positions.

Duties and Responsibilities

Handles workers’ compensation 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.

Competencies

Qualifications

High School diploma or GED required. Bachelor’s degree preferred.

Three years of previous claims handling experience. Previous experience in workers’ compensation preferred. In lieu of this, a bachelor’s degree in any field is required. Familiarity with medical bill processing system preferred. Pursuit AIC37, AIC44 and medical interpretation courses preferred.

Willingness to obtain and maintain any required licenses. Valid driver’s license required.

Physical Requirements