Workers' Compensation Claims Representative III (Remote)

MEM Insurance • Kansas City, MO

5d • Remote

About The Position

MEM Insurance is seeking a seasoned Claims Representative to join our dynamic Claims team. In this role, you will manage a caseload of high-exposure workers’ compensation claims, oversee advanced medical case management, and develop tailored Return-to-Work plans. You’ll collaborate with vocational consultants, legal counsel, and internal teams to ensure compliance, negotiate settlements, and deliver exceptional service to our policyholders. This position offers the opportunity to work independently while providing leadership on complex claims and contributing to workflow improvements.

Requirements

• High school diploma or equivalent required
• 3–5 years of claims handling experience, primarily in Workers’ Compensation.
• Valid driver’s license required

Nice To Haves

• bachelor’s degree preferred
• Associate in Claims (AIC) designation preferred
• Texas-All Lines license preferred
• Missouri experience preferred

Responsibilities

• Manage complex workers’ compensation claims involving high financial exposure, sensitive issues, or extended life cycles.
• Investigate coverage and compensability, ensuring thorough documentation and compliance with state statutes.
• Oversee advanced medical case management, including coordination with Nurse Case Managers and external vendors.
• Develop and implement Return-to-Work plans for high-risk claims, collaborating with vocational consultants and legal counsel.
• Identify and investigate potential fraud and subrogation opportunities, partnering with the Special Investigation Unit.
• Establish and maintain accurate claim reserves within authority levels, ensuring timely responsiveness to changing circumstances.
• Evaluate and negotiate settlements within approved authority levels, including structured settlements and Medicare compliance.
• Collaborate with legal counsel to manage litigation and ensure adherence to MEM guidelines.
• Maintain accurate system data and prepare reports for management on high-profile claims.
• Foster cross-departmental collaboration with Underwriting, Premium Consultation, and Loss Prevention.
• Provide mentorship and training to junior adjusters, supporting professional growth and team development.

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: Mid Level
• Education Level: High school or GED