Senior Claims Representative

🔥 5 minutes ago

🌽 Illinois, Iowa, +4 more states – Remote

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

⏰ Full Time

🟠 Senior

📋 Claims Specialist

👻 Ghost score 10%

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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 highly complex workers’ compensation claims involving significant financial exposure, legal intricacies, and extended life cycles • Conduct advanced investigations into coverage, compensability, fraud, and loss prevention • Oversee medical case management for catastrophic injuries and lifetime care needs • Review and authorize large or complex medical bills and negotiate adjustments to control costs • Develop return-to-work strategies with policyholders, legal counsel, and vocational consultants • Ensure accurate benefit calculations for high-exposure claims • Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery • Partner with legal teams on complex settlements and litigation processes • Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement • Identify structured-settlement opportunities and lead negotiations • Produce strategic reports on high-profile claims and prepare claims for Corporate Plan of Action meetings • Lead cross-departmental claims-handling and risk-management improvements • 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

🎯 Requirements

• 7–10 years of claims handling experience, with high exposure to Workers’ Compensation • 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 • Valid driver’s license required • Ability to manage highly complex, high-exposure workers’ compensation claims • Experience conducting advanced coverage, compensability, fraud, subrogation, and loss-prevention investigations • Knowledge of nuanced statutory interpretations and regulatory compliance • Experience overseeing medical case management for catastrophic injuries and lifetime care needs • Experience reviewing and authorizing large or complex medical bills and negotiating adjustments • Experience developing return-to-work strategies and calculating benefits while addressing tax and compliance risks • Experience negotiating complex settlements, managing litigation processes, Medicare Set-Asides, and CMS engagement • Ability to produce strategic claims reports and maintain system data integrity • Ability to mentor and coach junior and intermediate adjusters

🏖️ Benefits

• Medical, dental, and vision health plans, including fertility benefits, fully paid preventive care, and adult orthodontia • Employer-paid life insurance equal to 3x base salary • Employer-paid AD&D insurance • Employer-paid short- and long-term disability • Employer-paid wellness and recognition incentives for employees and spouses • Flexible Spending Account and dependent care options • Health Savings Account with generous employer contribution • Generous paid time off • 11 holidays and 4 early releases • 16 hours volunteer time off • 20 days paid parental leave • Marriage, bereavement, and jury duty leave • Employee Assistance Programs • 401(k) retirement plan with employer match and profit sharing • Adoption assistance • Tuition assistance