Workers' Enhanced Medical Representative

About 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. We are an  A  rated, $2.0B award‑winning property & casualty insurance carrier operating along the Eastern half of the United States. Our home office is in Central New York, with regional offices including New York City, Dallas, and Charlotte.

This is a hybrid position reporting to our New Hartford, NY location.

The Enhanced Medical Only (EMO) role is a workers' compensation claims representative position. You will handle low‑complexity claims that are first‑party and classified as medical only. In this role, you will use investigation, evaluation, and negotiation skills to resolve claims, and communicate in writing and by telephone with 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 future growth and career pathing potential within the Workers' Compensation Department.

• 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.

• College degree or equivalent experience preferred.
• 1-2 years of previous claims experience preferred but not required; professional customer service experience is beneficial.

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.

$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.

• 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,  Protection, Pet Insurance
• Student Loan Refinancing Services
• 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

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

Utica National is an Equal Opportunity Employer.