Senior Workers' Compensation Senior Claims Representative (Remote)

MEM Insurance • Kansas City, MO

5d • 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 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 are empowered and supported in solving challenges and making a meaningful impact.

Requirements

• 7–10 years of claims handling experience, with high exposure to Workers’ Compensation.
• Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain.
• Texas All-Lines license preferred.
• Valid driver’s license required.

Nice To Haves

• Bachelor’s degree in business or related field preferred, or equivalent industry experience.

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 insurance
• Fertility benefits
• Fully paid preventative care
• Adult orthodontia
• Employer-Paid Life Insurance (3x base salary)
• AD&D insurance
• Short and Long-term Disability insurance
• Wellness and Recognition Program with employer-paid incentives for employees and spouses
• Flexible Spending Account
• Dependent Care options
• Health Savings Account with 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 with employer match
• Profit sharing
• Adoption Assistance
• Tuition Assistance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior