Medical Management Specialist

Erie Insurance
Hagerstown, MD
Jul 17, 2017
Aug 07, 2017
Full Time
Job Description Position Summary Within designated authority, handles medical management claims with limited supervision. Selected candidate may fwork from either the Hagerstown, MD Claims Office or the Silver Spring, MD Branch. 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. 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; Bachelors Degree required Strong working knowledge of applicable state laws required. Good working knowledge of human anatomy and medical terminology required. 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 required where applicable. 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: Hagerstown Job Segment: Law, Claims, Compliance, Legal, Insurance

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