Claims Specialist

• Accurately performs billing and collections for multiple facilities for all payors.
• Provide professional and technical support to staff across multiple departments.
• Respond to inquiries from insurance carriers, patients, and family members regarding billing and account balance questions.
• Monitor and review financial systems to ensure accurate revenue recognition and maintain appropriate accounts receivable levels aligned with payer mix and acuity.
• Collaborate with Utilization Management departments to ensure pre-certifications, authorizations, and appeals are completed accurately and on time.
• Perform effective and timely follow-up on insurance claims to secure appropriate reimbursement.
• Analyze explanations of benefits (EOBs), remittances, and explanations of payment (EOPs) to identify discrepancies or underpayments.
• Research and resolve claim issues
• Prepare, submit, and track appeals for denied claims through resolution.
• Prepare for and actively participate in weekly Accounts Receivable (AR) meetings.

Claims Analyst

• Manage complex insurance claims in a key-pointed area, work independently, schedule appointments for vehicle inspections, and travel throughout your key-point territory.
• Conduct thorough coverage investigations, including fire, theft, false pretense claims, and coverage decisions for floor-planned units.
• Prepare accurate damage estimates using computerized estimating systems (e.g., Mitchell Connect) to establish the cost of repairs.
• Lead subrogation investigations, salvage disposal, and fraud investigations.
• Perform loss prevention reviews and provide essential dealer training activities.
• Remain on-call for CAT/Storm losses and be prepared for extensive travel away from home for extended periods of time.

Catastrophe Auto Claims Adjuster

• Investigates and adjudicates claims within designated authority, ensuring compliance with appropriate statutory laws.
• Verifies coverage, establishes and maintains reserves, secures recorded statements, drafts and processes correspondence, reports and records.
• Obtains additional information as required to determine liability.
• Documents claim files and facilitates processing of claims in collaboration with other departments.
• Establishes contact with all parties involved in the claim in accordance with ERIE’s expectations.
• Evaluates and negotiates claims, recognizes subrogation opportunities, and initiates action.
• Responds to inquiries from Policyholders, Agents, insurance carriers, claimants, assigned experts and others.

Inside Claims Representative I

• Work independently, processing claims via data entry for 90% of your day.
• Be responsible for effectively adjudicating claims to meet production, quality, and other metrics in accordance with policy/procedures and regulatory guidelines.
• Follow up on claims needing additional information.
• Refer problem claims to a Lead and/or auditor for additional review.
• Make sure that the integrity of the information is accurate and kept private according to HIPPA guidelines.
• Work with specific software.
• May be assigned special projects.

Health Claims Specialist

• Analyzing and processing claims through well-developed action plans to an appropriate and timely resolution by investigating and gathering information to determine the exposure on the claim.
• Negotiating settlement of claims within designated authority.
• Communicating claim activity and processing with the claimant and the client.
• Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.

Liability Claims Representative – CA, OH, IN, KY Jurisdictional Knowledge – Licensing Required

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property losses and damages.
• Effectively communicate and negotiate with policyholders, agents, public adjusters, attorneys, and service providers via phone, email, and internal systems to accurately document claim details.
• Successfully manage a pending claim load at varying stages of the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Interpret and apply computer generated loss estimates, engineer’s reports, and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.
• Mentor our mid and associate level claims representatives.

Complex Claims Representative

• Manage the claims reporting process for agency clients.
• Report claims to the appropriate carrier and maintain records in the agency management system by documenting claim actions in accordance with established procedures.
• Follow up on claim to obtain the specific adjuster and claim number relevant to the reported loss.
• Notify appropriate parties when a claim is processed with carrier, providing accurate and timely claim information.
• Continuously monitor claims until claims are closed by the insurance carrier.
• Report any potential issues with a claim to the client's Account Manager and Producer, escalating to management as needed.
• Prepare reports by collecting and summarizing information as requested by management.

Commercial Lines Claims Specialist

• Examining and appropriately interpreting insureds’ policies, forms in force, and other records to determine coverage and extent of the company’s exposure and policy limitations
• Applying knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations, and guidelines
• Desk reviewing, drafting, adjusting, and approving estimates of damage and loss amounts for structural damages, mitigation, remediation, etc
• Using varying methods of investigation, including taking recorded statements, consulting with experts, identifying property damage, and reviewing documentation
• Keeping active communication and working with customers, their representatives, contractors, and experts throughout the Claims process from first notice of the claim through repair completion
• Working with public adjusters and attorneys that may represent the insured(s) and responding to all notices and letters in accordance with state guidelines

Senior Claims Adjuster, Large Loss

• Investigate, analyze, and determine the extent of liability concerning first party homeowner property large losses and damages of $100K+.
• Negotiate settlements and make payments within scope of authority, settling claims timely, and in the most cost-effective manner.
• Effectively communicate with policyholders, agents, and service providers via phone, email, and internal systems to accurately document claim details.
• Effectively manage loss and expense reserves to ensure accurate and timely reserving practices on all large loss claim exposures.
• Create and maintain comprehensive claim handling documentation in the electronic claims management system and related applications including the completion and escalation of Large Loss Reports (LLR’s).
• Ability to successfully manage a pending claim volume at varying stages in the claims process.
• Interpret and apply the details of an insurance policy to ensure the accuracy of payments and claims declinations.
• Ability to understand, computer generated loss estimates and construction terminology.
• Update and maintain comprehensive claim handling notations in our electronic claims management system and other related applications.

Claims Specialist – Large Loss

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Claims Specialist II

• Accurately performs billing and collections for multiple facilities for all payors.
• Provide professional and technical support to staff across multiple departments.
• Respond to inquiries from insurance carriers, patients, and family members regarding billing and account balance questions.
• Monitor and review financial systems to ensure accurate revenue recognition and maintain appropriate accounts receivable levels aligned with payer mix and acuity.
• Collaborate with Utilization Management departments to ensure pre-certifications, authorizations, and appeals are completed accurately and on time.
• Perform effective and timely follow-up on insurance claims to secure appropriate reimbursement.
• Analyze explanations of benefits (EOBs), remittances, and explanations of payment (EOPs) to identify discrepancies or underpayments.
• Research and resolve claim issues.
• Prepare, submit, and track appeals for denied claims through resolution.
• Prepare for and actively participate in weekly Accounts Receivable (AR) meetings.

• Manages an inventory of claims to evaluate compensability/liability
• Conducts claim investigations to confirm coverage and to determine liability, compensability and damages
• Determines and may negotiate appropriate claim settlements/reserves within prescribed authority
• May attend arbitrations, mediations, depositions, or trials
• Conveys routine to moderately complex information regarding coverage and settlements to insureds, claimants, and external partners
• May authorize payments in accordance with assigned authority limit and ensures payments are made in a timely manner
• Maintains accurate and detailed claim files, including all correspondence, reports, and settlement agreements
• Performs other duties as assigned.

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Claims Analyst

Catastrophe Auto Claims Adjuster

Inside Claims Representative I

Health Claims Specialist

Liability Claims Representative – CA, OH, IN, KY Jurisdictional Knowledge – Licensing Required

Complex Claims Representative

Commercial Lines Claims Specialist

Senior Claims Adjuster, Large Loss

Claims Specialist – Large Loss

Claims Specialist II

Claims Analyst

Claims Representative – Medical Only

Commercial Lines Claims Specialist