Claim Specialist II or III-NJ and PA

MEMIC • Portland, ME

1d • Remote

About The Position

The Claim Specialist investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. (Supervisor will determine actual individual authority up to the stated maximum). Conducts training classes (including research and position papers) for less experienced Claim Department Representatives. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.

Requirements

• 3+ years workers' compensation lost time claim handling experience required.
• Strong attention to detail and excellent verbal and written communication skills.
• Proficiency in Microsoft Office Suite (Word and Excel) required and Imageright preferred.
• Self-motivated, flexible, and capable of managing time and priorities effectively in a fast-paced environment.
• Ability to collaborate and build relationships with cross-functional teams.
• Valid driver’s license required.
• Must have required adjuster's licenses in applicable states. (NJ and PA)

Responsibilities

• Investigate, evaluate, negotiate and resolve medical-only and lost time claims within settlement and reserving authority up to stated maximum.
• Serve as a point of contact for insureds, injured workers, agents, brokers, attorneys, and other stakeholders to gather necessary information and provide timely updates.
• Administer medical and indemnity benefits in compliance with NJ and PA state workers’ compensation statutes and MEMIC’s best practices.
• Maintain organized and high-quality claim files in accordance with company policies and procedures.
• Implement Managed Care strategies, coordinate rehabilitation plans, process medical bills, and monitor case progress.
• Interact with state and federal boards and commissions to ensure proper reserves and compliance with laws and regulations.
• Stay updated on state laws and workers’ compensation trends through MEMIC-provided training and external certifications like WCP or Claims Law (AEI).

Benefits

• Health, dental, and vision insurance, plus an annual wellness reimbursement.
• 401(k) retirement plan with up to 6% match, profit sharing, and life insurance.
• Five weeks of PTO and 11 paid holidays.
• Student loan paydown assistance, tuition reimbursement, and professional development opportunities.
• Paid volunteer day each year.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed