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UM
Utica Mutual Insurance Company
Workers Compensation Enhanced Medical Only Representative
Career Insights for Claims Representative
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Based on New York data
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What they do
A Claims Representative accepts and reviews applications for insurance and provides information to insurance agents. Assists insurance customers, answers questions and processes requests to change or cancel policies. May assist with insurance claims that are disputed, review claims and policy coverage and help to negotiate agreements between customers and an insurance company.
$56,130 / year median in New York
+4% projected growth
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, based in our Home Office in Central New York, with Regional Office locations including NYC, Dallas and Charlotte. This is a hybrid position reporting to our New Hartford, NY location. What you will do The Enhanced Medical Only (EMO) role is a workers' compensation claims representative position. You will be responsible for handling low complexity claims that are first party and classified as medical only. In this position, 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 important step to building knowledge and skills and may support room for future growth and career pathing potential within the Workers' Compensation Department! Key responsibilities 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. 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. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.