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MEM · 2 weeks ago

Workers' Compensation Claims Representative (Remote)

United States

Full-time

Remote

Mid Level

3+ years exp

MEM Insurance is seeking an experienced Claims Representative to join their dynamic Claims team. In this role, you will manage a caseload of high-exposure workers’ compensation claims and collaborate with various stakeholders to ensure compliance and deliver exceptional service to policyholders.

Fleet ManagementHealth InsuranceInsurance

Responsibilities

Manage complex workers’ compensation claims involving high financial exposure, sensitive issues, or extended life cycles

Investigate coverage and compensability, ensuring thorough documentation and compliance with state statutes

Oversee advanced medical case management, including coordination with Nurse Case Managers and external vendors

Develop and implement Return-to-Work plans for high-risk claims, collaborating with vocational consultants and legal counsel

Identify and investigate potential fraud and subrogation opportunities, partnering with the Special Investigation Unit

Establish and maintain accurate claim reserves within authority levels, ensuring timely responsiveness to changing circumstances

Evaluate and negotiate settlements within approved authority levels, including structured settlements and Medicare compliance

Collaborate with legal counsel to manage litigation and ensure adherence to MEM guidelines

Maintain accurate system data and prepare reports for management on high-profile claims

Foster cross-departmental collaboration with Underwriting, Premium Consultation, and Loss Prevention

Provide mentorship and training to junior adjusters, supporting professional growth and team development

Qualification

Workers' Compensation claimsAdvanced medical case managementAssociate in Claims (AIC)Claims handling experienceCollaboration

Required

High school diploma or equivalent required

Valid driver's license required

3–5 years of claims handling experience, primarily in Workers' Compensation

Preferred

bachelor's degree preferred

Associate in Claims (AIC) designation preferred

Texas-All Lines license preferred

Benefits

Health Plans: Medical, Dental, and Vision Includes fertility benefits, fully paid preventative care, and adult orthodontia.

Employer-Paid Life and Disability Benefits: Life Insurance (3x base salary), AD&D, Short and Long-term Disability.

Wellness and Recognition Program: Employer-paid incentives for employees and spouses.

Flexible Spending Account and Dependent Care options

Health Savings Account: Generous employer contribution.

Time Away from Work: Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave.

Employee Assistance Programs

401k Retirement Plan: Employer match and profit sharing.

Adoption Assistance and Tuition Assistance