Workers' Compensation Claims Representative III

🔥 8 minutes ago

🌽 Illinois, Iowa, +4 more states – Remote

🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🌾 Nebraska – Remote 🏰 Missouri – Remote 🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

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MEM

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1995

🛡️ Insurance

Insurance

MEM is an insurance provider (insurer) that operates online portals for policyholders and agents and offers claims filing and management services. The company’s site references features such as “File a Claim,” agent and policyholder logins, programs and safety grants, and guidance for injured parties, indicating a focus on claims administration, risk mitigation programs, and agent/policyholder services.

📋 Description

• 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.

🎯 Requirements

• High school diploma or equivalent required; bachelor’s degree preferred. • Associate in Claims (AIC) designation preferred. • Valid driver’s license required; Texas-All Lines license preferred. • 3–5 years of claims handling experience, primarily in Workers’ Compensation. Missouri experience preferred.

🏖️ Benefits

• Health Plans: Medical, Dental, and VisionIncludes 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