Sr. NY PIP (Personal Injury Protection) Adjuster/No Fault

$63,712 - $101,774/Yr

Erie Insurance - Rochester, NY

Full-time - Mid Level

Rochester, NY

5,001-10,000 employees

Insurance Carriers and Related Activities

About the position

The Claims Department at Erie Insurance is seeking a dedicated professional to handle complex medical management claims and the litigation aspects of first-party claims. This position is based in the New York Branch Office and requires the successful candidate to exercise discretion and independent judgment in their work. The role involves managing a variety of claims, including those related to Personal Injury Protection (PIP) and No Fault insurance, as well as complex fatalities and wage loss claims. The candidate will be responsible for evaluating coverage, conducting thorough investigations, and determining the total value of claims while maintaining adequate reserves. Additionally, the position requires the handling of litigation portions of claims, working closely with defense counsel to develop litigation strategies and settle claims within the authority granted. The successful candidate will be expected to establish immediate contact with policyholders, claimants, agents, and legal counsel as necessary. Regular reviews of claim files will be required to ensure timely follow-up and closure of claims. The role also involves evaluating and processing claim-related bills and medical reports, determining the appropriate actions to take on claims, and identifying potential subrogation situations. Continuous professional development is encouraged, with attendance at industry-related training programs to stay current on legal developments and compliance with applicable laws. This position is essential to the operations of the Claims Department, and the incumbent will be expected to collaborate with various stakeholders, including internal teams and external vendors, to ensure efficient and effective claims management. The role also includes assisting in training branch office personnel and developing expertise in legal and medical terminology and procedures.

Responsibilities

• Handles first party medical benefit claims, including complex coverage, litigation, fatalities, wage loss claims, and suspected fraud cases.
• Evaluates and makes independent decisions regarding coverage and claims management.
• Conducts investigations, determines total value of claims, sets and maintains adequate reserves, and manages cases effectively.
• Handles the litigation portion of first party claims, settling within authority and collaborating with defense counsel on litigation strategy.
• Investigates and resolves complex coverage questions across multiple jurisdictions, ensuring compliance with state laws.

Requirements

• High School Diploma or GED with five years of previous Medical Management claims handling experience, or a Bachelor's Degree with three years of relevant experience.
• Strong working knowledge of applicable state laws and human anatomy.
• Expertise in state no-fault laws and civil law is required.
• Successful completion of AIC courses is preferred.
• Working knowledge of medical bill repricing systems is required.

Nice-to-haves

• Knowledge of multiple medical management jurisdictions is preferred.
• Appropriate license as required by state.

Benefits

• Premier health, prescription, dental, and vision benefits for employees and dependents, starting from the first day of work.
• Low contributions to medical and prescription premiums, with the company covering up to 97% of monthly premium costs.
• Traditional pension plan with vesting after five years of service.
• 401(k) plan with up to 4% contribution match in addition to the pension.
• Paid time off including vacation, personal days, sick days, bereavement days, and parental leave.
• Tuition reimbursement program for higher education and industry designations.
• Company-paid basic life insurance and short- and long-term disability insurance.
• Adoption assistance and fertility coverage.
• Well-being programs and paid volunteer hours for community service.