Medical Management Specialist

Salary range is for this level and may vary based on actual level of role hired for

* This range represents a national range and the actual salary will depend on several factors including the scope and complexity of the role and the skills, education, training, credentials, location, and experience of an applicant, as well as level of role for which the successful candidate is hired. Position may be eligible for an annual bonus payment.

At Erie Insurance, you’re not just part of a Fortune 500 company; you’re also a valued member of a diverse and inclusive team that includes more than 6,000 employees and over 13,000 independent agencies. Our Employees work in the Home Office complex located in Erie, PA, and in our Field Offices that span 12 states and the District of Columbia.

We strive to be Above all in Service® to our customers—and to our employees. That’s why Erie Insurance offers you an exceptional benefits package, including:

• Premier health, prescription, dental, and vision benefits for you and your dependents. Coverage begins your first day of work.
• Low contributions to medical and prescription premiums. We currently pay up to 97% of employees’ monthly premium costs.
• Pension. We are one of only 13 Fortune 500 companies to offer a traditional pension plan. Full‑time employees are vested after five years of service.
• 401(k) with up to 4% contribution match. The 401(k) is offered in addition to the pension.
• Paid time off. Paid vacation, personal days, sick days, bereavement days and parental leave.
• Career development. Including a tuition reimbursement program for higher education and industry designations.

Additional benefits that include company‑paid basic life insurance; short‑and long‑term disability insurance; orthodontic coverage for children and adults; adoption assistance; fertility and infertility coverage; well‑being programs; paid volunteer hours for service to your community; and dollar‑for‑dollar matching of your charitable gifts each year.

Do you have a passion for helping people through the claims process, especially when medical recovery and compassion matter most? Erie Insurance is seeking a Medical Management Specialist to join our New York Branch team in Rochester. This position plays a vital role in handling first‑party medical benefit claims and ensuring our policyholders receive the care and support they deserve.

• There is a potential for multiple positions to be available.

Manage first‑party medical benefit claims, including wage loss and fatality claims.

Investigate coverage, determine claim value, and ensure compliance with applicable state laws.

Analyze medical records and wage documentation to reach fair, accurate claim conclusions.

Collaborate with legal counsel on litigation cases and coordinate with investigative services when necessary.

Maintain contact with policyholders, claimants, agents, and medical providers to deliver outstanding service.

Assist in training branch staff and stay current on laws and medical management best practices.

You’re detail‑oriented, empathetic, and confident managing complex medical claim situations. You combine strong analytical skills with a calm, professional approach to resolving claims efficiently and fairly.

Within designated authority, handles medical management claims with limited supervision.

• Handles first party medical benefit claims, including fatalities and 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, evaluates, and resolves coverage questions in compliance with applicable state laws.
• Establishes immediate contact with Policyholders and Claimants. Contacts Agents as necessary.
• Reviews claim files on a regular basis and takes necessary follow‑up and/or closing action.
• Evaluates, processes and takes appropriate action…