Medical Only Claims Representative (Remote)

MEM Insurance•Omaha, NE

2d•Remote

About The Position

MEM Insurance is seeking a Medical‑Only Claims Representative to join their Claims team. This role involves managing a caseload of workers’ compensation medical‑only claims, ensuring timely, compliant, and thoughtful handling from first notice through closure. The representative will coordinate quality medical care, maintain accurate claim documentation, and collaborate with internal partners to deliver positive outcomes for injured workers, policyholders, and the organization. MEM Insurance emphasizes teamwork, accountability, and continuous learning in its claims handling approach, offering opportunities for claims expertise growth within a supportive, collaborative culture.

Requirements

High School diploma or equivalent required
One (1) or more years of experience in a customer service environment, with some exposure to medical terminology
Valid driver’s license required

Nice To Haves

Bachelor’s degree preferred
Associate in Claims (AIC) or other insurance designation preferred

Responsibilities

Manage a caseload of medical‑only workers’ compensation claims, ensuring compliance with applicable state regulations and MEM guidelines.
Investigate assigned claims for coverage, document coverage analyses, and promptly notify the appropriate teams of any potential issues requiring further review.
Oversee the medical aspects of each claim to support quality, appropriate, and cost‑effective care, including coordination with network providers, Utilization Management, and Nurse Case Management when appropriate.
Review and process medical bills accurately and timely while maintaining complete and well‑documented claim files.
Identify claims that involve increased complexity, potential compensability issues, subrogation, fraud, or Medicare exposure, and escalate or refer those claims to the appropriate internal partners.
Establish, maintain, and adjust claim reserves in a timely and well‑documented manner that reflects current claim exposure and corporate standards.
Identify and investigate potential third‑party liability and document subrogation opportunities to support recovery efforts.
Maintain accurate system data and file documentation to support regulatory compliance, reporting requirements, and data integrity.
Collaborate closely with internal teams across MEM, including Underwriting, Premium Consultation, Safety & Risk Services, and Corporate Claims, to support effective claim outcomes.
Communicate claim status clearly and professionally to policyholders, producers, and internal stakeholders, responding promptly to questions, concerns, or service needs.
Manage workload effectively to meet productivity and service standards, prioritizing tasks to move claims toward timely resolution.
Participate in ongoing training, legal updates, and state‑specific education to remain current on workers’ compensation laws and industry best practices.
Serve as a resource and support to teammates, contributing to a positive, collaborative team environment.

Benefits

Medical, Dental, and Vision
Fertility benefits
Fully paid preventative care
Adult orthodontia
Annual Performance Based Bonus
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
Dependent Care options
Health Savings Account: Generous employer contribution.
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
Tuition Assistance