Workers' Compensation Adjuster Ii

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 Hiring Manager will also consider candidates for Workers’ Compensation I. Level of position offered will be based upon the depth and breadth of selected candidate’s experience and qualifications.
• Successful candidate will serve Virginia / West Virginia.
• The candidate will work from home and live within the ERIE Footprint.

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.

Competencies

Qualifications

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

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. 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