9 hours ago

Sr. Medical Management Specialist (Personal Injury Protection) (Rochester, NY, US, 14692)

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 9 hours agoStatus: Live

Job Summary

Handle complex medical management first-party claims and the litigation portion of those claims, using independent judgment to evaluate coverage and make decisions. Investigate and resolve complex coverage questions across multiple jurisdictions, including issues involving suspected fraud or misrepresentation. Manage case value, reserves, billing, and medical/wage loss documentation, coordinate with defense counsel and relevant stakeholders, and ensure appropriate claim payments, compromises, or contests.

Location: Pittsburgh

Workplace: Onsite

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Mid level

Key Responsibilities

•Handle first-party medical benefit claims, including complex coverage, litigation, fatalities, wage loss claims, and suspected fraud/misrepresentation; evaluate and decide coverage and manage case reserves.
•Handle the litigation portion of first-party claims, settle within authority, and work with defense counsel on litigation strategy.
•Investigate, evaluate, and resolve complex coverage questions across multiple jurisdictions in compliance with applicable state laws.
•Investigate suspected fraud/misrepresentation and coordinate with ISS, Examiner, Underwriting, and counsel as needed.
•Review claim files regularly; evaluate claim-related bills and reports, calculate wage loss claims per state laws, and bring claims to conclusion.

Pay and Benefits

Salary: USD 66,287 - 105,886 annually

Perks:Health InsurancePrescriptionDentalVisionPension401kPaid LeaveLife InsuranceDisability InsurancePaid VolunteerAdoption AssistanceFertility CoverageWell-being Programs

Key Requirements

•5+ years of previous medical management claims handling experience with a High School Diploma or GED (or 3+ years with a Bachelor’s Degree).
•Experience with personal injury protection.
•Strong working knowledge of applicable state laws and state no-fault laws, including civil law knowledge.
•Strong working knowledge of human anatomy and medical terminology.
•Appropriate license as required by state (AIC courses preferred; working knowledge of a medical bill repricing system required).

Experience:5+ years

Education:Bachelor's

Skills:Customer focusCollaborationDecision qualityAccountabilityTrust

Tech Stack:Medical bill repricing system

Company Brief

Erie Insurance Group

Erie Insurance Group is a mutual insurance company providing auto, home, business, and life insurance products through a network of independent agents, serving customers across multiple U.S. states with a focus on local service and claims support.

Industry: Insurance

Company Size: Enterprise (1,001+ employees)

Growth: Established Company

Headquarters: Erie, United States

Founded: 1925

Website LinkedIn

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Erie Insurance Group

9 hours ago

Sr. Medical Management Specialist (Personal Injury Protection) (Rochester, NY, US, 14692)

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI

Last checked: 9 hours agoStatus: Live

Job Summary

Location: Pittsburgh

Workplace: Onsite

Employment Type: Full time

Job Function: Healthcare (Clinical, Medical, Wellness)

Seniority: Mid level

Key Responsibilities

•Handle first-party medical benefit claims, including complex coverage, litigation, fatalities, wage loss claims, and suspected fraud/misrepresentation; evaluate and decide coverage and manage case reserves.
•Handle the litigation portion of first-party claims, settle within authority, and work with defense counsel on litigation strategy.
•Investigate, evaluate, and resolve complex coverage questions across multiple jurisdictions in compliance with applicable state laws.
•Investigate suspected fraud/misrepresentation and coordinate with ISS, Examiner, Underwriting, and counsel as needed.
•Review claim files regularly; evaluate claim-related bills and reports, calculate wage loss claims per state laws, and bring claims to conclusion.

Pay and Benefits

Salary: USD 66,287 - 105,886 annually

Perks:Health InsurancePrescriptionDentalVisionPension401kPaid LeaveLife InsuranceDisability InsurancePaid VolunteerAdoption AssistanceFertility CoverageWell-being Programs

Key Requirements

•5+ years of previous medical management claims handling experience with a High School Diploma or GED (or 3+ years with a Bachelor’s Degree).
•Experience with personal injury protection.
•Strong working knowledge of applicable state laws and state no-fault laws, including civil law knowledge.
•Strong working knowledge of human anatomy and medical terminology.
•Appropriate license as required by state (AIC courses preferred; working knowledge of a medical bill repricing system required).

Experience:5+ years

Education:Bachelor's

Skills:Customer focusCollaborationDecision qualityAccountabilityTrust

Tech Stack:Medical bill repricing system

Company Brief

Erie Insurance Group

Industry: Insurance

Company Size: Enterprise (1,001+ employees)

Growth: Established Company

Headquarters: Erie, United States

Founded: 1925

Website LinkedIn