Worker's Compensation Maintenance Claims Representative

Utica National Insurance Group

Claim Representative handling primarily NY workers' compensation maintenance files involving claims with lifetime exposures. Communicating with insureds and medical providers in a hybrid role from Utica National Insurance Group.

Posted 7/31/2026full-timeCharlotte, New Hartford • New Jersey, New York, North Carolina, Pennsylvania • 🇺🇸 United StatesJuniorMid-Level💰 $44,000 - $55,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in handling workers' compensation claims, including medical bill review, indemnity checks, and compliance with treatment guidelines. Proficient in communication with various stakeholders and managing claim assignments effectively.

Highest-signal resume keywords

Workers' Compensation Claims ManagementMedical Bill ReviewClaims Adjuster LicenseDiary ManagementClaims Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingIndemnity Check IssuanceCompensability EvaluationActivity ChecksAnnual ReportingMedical Treatment GuidelinesReserve SettingIME ManagementUR ManagementPeer Review Management

Soft Skills

Effective CommunicationAttention to DetailOrganizational SkillsProblem-SolvingCustomer Service

Certifications & Qualifications

Claims Adjuster License

Industry Keywords

Northeastern States Claims ExperienceInsurance CourseworkQuality Program CriteriaCorporate Policies Compliance

About the role

Key responsibilities & impact

Handle maintenance files, receiving and handling all WC claims involving lifetime exposures of lost time and/or medical treatment.
Review medical bills, issue indemnity checks, apply medical treatment guidelines.
Tasks include, but are not limited to: diary management, mail management, setting reserves, evaluation of compensability of treatment, annual reporting, age changes, activity checks, IME, UR, or Peer Reviews and other duties as assigned.
Communicate directly with insureds, claimants, medical providers and others by telephone and through written correspondence.
Occasionally settle smaller claims.
Handle all claim assignments in accordance with quality program criteria.
Follow directives and instructions from the Claims Supervisor.
Performs other duties as assigned. Conforms with all corporate policies and procedures.

Requirements

What you’ll need

Bachelor's Degree preferred or equivalent experience; Insurance coursework is helpful.
2-3 years previous claims experience preferred.
NY claims experience preferred; knowledge of other Northeastern states helpful.
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.

Benefits

Comp & perks

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