Claim Specialist III

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MEMIC

WebsiteLinkedInAll Job Openings

201 - 500 employees

💼 Consulting

🏥 Healthcare

🛡️ Insurance

💰 $96M Series D on 2021-04

Consulting • Healthcare • Insurance

MEMIC is a company that provides workers' compensation insurance services. They focus on promoting workplace safety and offering comprehensive support for employers and workers. MEMIC offers various services such as injury reporting, claims management, and safety consulting. The company is committed to preventing fraud and providing educational resources and support through workshops and webinars. MEMIC aims to be a reliable partner in workplace safety and is involved in community outreach initiatives like safety campaigns. They offer various online services for managing insurance policies and claims efficiently.

📋 Description

• Investigate, evaluate, negotiate, and resolve lost time claims within settlement and reserving authority • Communicate with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to determine coverage, compensability, loss facts, and liability/exposure • Administer timely, appropriate, and accurate indemnity and medical benefits • Evaluate claim exposure and resolve claims • Work with defense counsel on litigated cases; attend mediation, arbitration, and hearings as necessary • Develop litigation plans, track adherence, control legal expenses, and support effective resolution • Visit insureds and employees and make presentations as needed • Maintain quality claim files according to best practices and company procedures • Implement managed care strategies, coordinate rehabilitation or medical management, process bills, review mail through Image Right, and monitor progress • Interact with State and Federal Boards and Commissions and establish appropriate reserves • Mentor and train less experienced Claim Department representatives • Stay current on state laws and company claims procedures and educate injured workers and insureds • Prepare and present files for Agent/Broker Reviews and Insured File Review • Handle workers’ compensation, U.S. Longshoreman’s, and Jones Act claims using relevant medical terminology and procedures • Participate in internal and external training programs • Maintain working knowledge of company computer systems • Travel throughout States as required to handle assigned claims inventory • Continue claims education through Associate in Claims or Claims Law (AEI) courses

🎯 Requirements

• Candidates must have GA, VA, TN claims experience • Three years of workers’ compensation lost time and medical-only claim handling experience preferred • Bachelor’s degree preferred • Computer skills, including Word, Excel, and Image Right, preferred • Must have a valid driver’s license • Strong attention to detail • Strong verbal and written communication skills • Adaptable, flexible, and self-directed • Ability to manage time, multiple priorities, and resources wisely • Ability to work effectively with other organizational team members

🏖️ Benefits

• Health Insurance options, Dental Insurance options and Vision Insurance • Employee Life Insurance/AD&D and Dependent Life Insurance options • Short-term & Long-term Disability • Health Savings Account with potential employer match • Flexible Medical and Dependent Care Account • Accident Insurance • Critical Illness Insurance • Employee Assistance Program • Legal/Identify Theft Insurance options • Long Term Care Insurance • Pet Insurance • 401 (k) Retirement Plan with match up to 6%, plus annual bonus based on individual & company performance. • 5 weeks of Paid Time Off (PTO) • 11 paid holidays • Flextime schedules • Paid Parental Leave • Student loan paydown and refinancing assistance • Educational assistance for job related courses, seminars, certifications or degrees • One paid day every year to volunteer for your non-profit of choice • Sit-Stand desks & daily stretch breaks