Workers' Compensation Enhanced Medical Only Representative

About the role

The Enhanced Medical Only (EMO) role is a workers' compensation claims representative position at Utica National Insurance Group. This is a hybrid position reporting to our New Hartford, NY location.

Key Responsibilities

• Receive and set up claims assignments from the insured
• Review incoming loss notices and assign accordingly to claim representatives within the unit or send to the appropriate regional claim office
• Investigate first party, low severity Workers’ Compensation medical claims
• Confirm compensability & coverage
• Communicate directly with the insured’s, medical providers, agents, and vendors by telephone and in writing
• Review and approve medical treatments and associated medical bills
• Maintain strict diary on all active files
• Follow directives and instructions from Claims Supervisors and superiors
• Adhere to the WC Claims Best Practices, Workers’ Compensation statutes, bulletins, and attend company training classes
• Provide exceptional customer service
• Adhere to mandated state regulations
• Operate within a rules-based environment with a strong customer satisfaction emphasis
• Perform other tasks as assigned by management in relation to daily operations
• Monitor and update Medicare reporting

What You Need

• College degree or equivalent experience preferred
• 1-2 years of previous claims experience preferred but not required; professional customer service experience is beneficial
• Licensing Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims

Salary and Benefits

Salary range: $46,000 - $53,500

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 include:

• 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