Senior Workers' Compensation Claims Representative (Remote)
About The Position
Are you a seasoned claims professional with a passion for navigating complex cases? MEM Insurance is seeking a Senior Claims Representative to join our Claims team. In this pivotal role, you’ll manage high-exposure workers’ compensation claims, lead investigations into coverage and fraud, and collaborate across departments to drive strategic outcomes. You’ll be a key decision-maker, a mentor to junior adjusters, and a champion of process improvement—all while ensuring exceptional service and regulatory compliance. At MEM Insurance, we don’t just protect our customers—we empower our employees. We foster a culture of integrity, collaboration, and innovation. Our team thrives on solving challenges together, supporting one another, and making a meaningful impact in the lives of our policyholders and injured workers.
Requirements
- Bachelor’s degree in business or related field preferred, or equivalent industry experience.
- 7–10 years of claims handling experience, with high exposure to Workers’ Compensation.
- Valid driver’s license required.
Nice To Haves
- 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 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
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Senior
