Workers' Compensation Enhanced Medical Only Representative (Entry-Level)

The Company  

At Utica National Insurance Group, 1,400 employees countrywide take our corporate promise to heart every day: To make people feel secure, appreciated, and respected.

Utica National Insurance Group is an "A" rated $2.0B award-winning, nationally recognized property & casualty insurance carrier.

Operating along the Eastern half of the United States, our Home Office is based in Central New York, with Regional Office locations in NYC, Dallas and Charlotte.

What you will do

In this role, you will be responsible for handling claims that are first party and classified as medical only. You will use skills in investigation, evaluation, and negotiation to resolve claims. Communication skills will also be applied to correspond in writing and over the phone with individuals including injured workers, insureds, agents, vendors, team members, and defense counsel. The EMO role is an entry-level position and will get you started for future growth and career pathing potential within the Workers' Compensation Department!

Essential Functions:

• Receive claims assignments consisting of insured and claimant accident reports.


• Handle first party, medical-only claims claims. 


• Adjust, negotiate and settle justified claims for proper amounts within authorization or as directed by the supervisor.


• Determine extent of injury, coverage questions and medical values by evaluating all the facts developed through investigation.


• This position will have numerous contacts with, including but not limited to, injured workers, insureds, agents, and vendors by telephone and in writing.


• Review incoming loss notices and assign accordingly to claim representatives within unit or send to appropriate handling office/region.


• Required to take recorded statements as directed by supervisor on claims with compensability or 3rd party investigations.


• Handle and assign hearing notices to defense counsel.


• Work on bringing claim files to closure.


• Responsible for setting medical, other, and legal incurred when appropriate.


• Check medical reports, prior authorizations, bills, invoices, and other information for each individual claim, ensuring we are paying for appropriate injury sites.


• Review and study claim practices, policy coverages, procedures, bulletins, and attend company training classes.


• Perform other tasks as assigned by management in relation to daily operations.


• Operate within a rules-based environment with a strong customer satisfaction emphasis.


• Adhere to mandated state regulations.


• Performs other duties as assigned.


• Conforms with all corporate policies and procedures.

What you need

• Bachelor's Degree preferred or equivalent experience.


• 2-4 years previous claims experience preferred but not required.