Workers' Compensation Enhanced Medical Only Representative

Utica National Insurance Group

Workers' Compensation Claims Representative responsible for handling low complexity claims. Working at Utica National Insurance Group in New Hartford, NY in a hybrid role.

Posted 7/10/2026full-timeNew Hartford • New York • 🇺🇸 United StatesJuniorMid-Level💰 $46,000 - $53,500 per yearWebsite

About the role

Key responsibilities & impact

Receive and set up claims assignments from the insured First Notice of Loss reports
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

Requirements

What you’ll 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
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
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 benefits and perks as specified

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Claims AssignmentMedical Claims ReviewCompensability ConfirmationMedical Bill ApprovalDiary Maintenance

Soft Skills

CommunicationCustomer SatisfactionAttention to Detail

Certifications

Adjuster License