Worker's Compensation Maintenance Claims Representative (hybrid)

Utica National Insurance Group•Woodbury, NY

2d•$44,000 - $55,000•Hybrid

About The Position

In this role, you'll handle primarily NY workers' compensation maintenance files which involve claims that have lifetime exposures of medical treatment and/or lost time. Skills in detail orientation will be used to manage a diary, handle incoming mail, review medical bills, issues checks, and follow medical treatment guidelines. With your customer service abilities, you will also communicate directly with insureds, claimants, and medical providers. This role will be a hybrid position reporting to New Hartford, NY; Woodbury, Long Island; or Charlotte, NC.

Requirements

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.

Responsibilities

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.

Benefits

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