Senior Claims Representative (Remote)
MEM
•$72,800 - $109,200•Remote
About The Position
MEM Insurance is seeking a Senior Claims Representative to join their Claims team. This role involves managing high-exposure workers’ compensation claims, leading investigations into coverage and fraud, and collaborating across departments. The Senior Claims Representative will be a key decision-maker, mentor to junior adjusters, and a champion of process improvement, ensuring exceptional service and regulatory compliance. MEM Insurance fosters a culture of integrity, collaboration, and innovation, where employees solve challenges together and support each other.
Requirements
- 7–10 years of claims handling experience, with high exposure to Workers’ Compensation.
- Valid driver’s license required.
Nice To Haves
- Bachelor’s degree in business or related field preferred, or equivalent industry experience.
- Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain.
- Texas All-Lines license preferred.
Responsibilities
- Manage highly complex claims involving significant financial exposure, legal intricacies, and extended life cycles.
- Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations.
- Oversee medical case management for catastrophic injuries and lifetime care needs.
- Review and authorize large or complex medical bills, negotiating adjustments to control costs.
- Develop comprehensive RTW (Return-to-Work) strategies in collaboration with policyholders, legal counsel, and vocational consultants.
- Ensure precision in benefit calculations for high-exposure claims, addressing tax and compliance risks.
- Strategically deploy investigative efforts aligned with broader claims strategy.
- Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit.
- Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery.
- Partner with legal teams to negotiate complex settlements and manage litigation processes.
- Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement.
- Identify opportunities for structured settlements and lead negotiations.
- Produce strategic reports on high-profile claims to guide management decisions.
- Maintain system data integrity and prepare claims for Corporate Plan of Action meetings.
- Lead cross-departmental efforts to improve claims handling and risk management.
- Resolve escalated customer service issues and support high-value accounts.
- Participate in workflow improvement initiatives and committees.
- Mentor and coach junior and intermediate adjusters.
- Review escalated claims and provide actionable feedback.
- Support workforce development and succession planning.
Benefits
- Medical, Dental, and Vision Health Plans
- Fertility benefits
- Fully paid preventative care
- Adult orthodontia
- Employer-Paid 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 leave
- Bereavement leave
- Jury Duty leave
- Employee Assistance Programs
- 401k Retirement Plan: Employer match and profit sharing.
- Adoption Assistance
- Tuition Assistance
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What This Job Offers
Job Type
Full-time
Career Level
Senior
