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

Utica National Insurance Group; City of Utica (NY); On-site; USD 46,000 - 59,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

401(k)

Job summary

Utica National Insurance Group in Central New York is seeking an entry-level EMO claims handler for the Workers' Compensation Department. You will use investigation, evaluation, and negotiation skills to resolve first-party medical-only claims and bring files to closure.

The role involves frequent phone and written communication with injured workers, insureds, agents, vendors and defense counsel, with licensing required to adjust claims in the assigned states and opportunities for growth within

Qualifications

• 2–4 years claims experience preferred but not required.
• Bachelor's Degree or equivalent experience.

Responsibilities

• Handle first-party, medical-only claims and adjust, negotiate and settle within authorization.
• Determine injury extent and coverage by evidence gathered through investigation.
• Communicate with injured workers, insureds, agents, vendors and defense counsel by phone and in writing.
• Review medical reports, prior authorizations, bills, and other documents for accurate payments.

Skills

Claims handling

Investigation

Negotiation

Communication

Education

Bachelor's Degree

Job description

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.

Licensing

Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.

Salary range:

$46,000 - $59,000

The final salary to be paid and position within the internal salary range is reflective of the employee's work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications.

Benefits

• Medical and Prescription Drug Benefit
• Dental Benefit
• Vision Benefit
• Life Insurance and Disability Benefits
• 401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)
• Health Savings Account (HSA)
• Flexible Spending Accounts
• Tuition Assistance, Training, and Professional Designations
• Company-Paid Family Leave
• Adoption/Surrogacy Assistance Benefit
• Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance
• Student Loan Refinancing Services
• Care.com Membership with Back-up Care, Senior Solutions
• Business Travel Accident Insurance
• Matching Gifts program
• Paid Volunteer Day
• Employee Referral Award Program
• Wellness programs
• Personal insurance discount

Additional Information

This position is a full time hourly, non-exempt (overtime eligible) position.

Utica National is an Equal Opportunity Employer.