Claims Representative II

About the role

Are you a detail-oriented professional with a passion for helping others and navigating complex situations? MEM Insurance is seeking a Claims Representative to join our collaborative and mission-driven Claims team. In this role, you’ll manage a caseload of moderately complex workers’ compensation claims, ensuring quality care for injured workers while protecting the financial integrity of our policyholders. You’ll work closely with internal teams, policyholders, and external partners to investigate claims, develop return-to-work strategies, and negotiate fair settlements. If you thrive in a fast-paced environment and are committed to making a meaningful impact, we’d love to hear from you.

At MEM Insurance, we are committed to our vision, mission, and values. We foster a culture of collaboration, integrity, and innovation. Our team is passionate about delivering exceptional service to our customers while supporting each other’s growth and success. We believe in accountability, continuous learning, and creating an environment where employees feel valued and empowered.

Responsibilities

• Investigate and manage moderately complex workers’ compensation claims, ensuring compliance with state laws and MEM guidelines.
• Analyze statements and records to determine compensability and communicate findings to stakeholders.
• Collaborate with Nurse Case Managers and external vendors to oversee medical case management, including lifetime care planning and permanent restrictions.
• Develop tailored Return-to-Work (RTW) strategies in partnership with policyholders, ensuring accommodations align with medical restrictions.
• Calculate and issue accurate disability benefits in accordance with statutory requirements.
• Identify and investigate potential fraud or abuse in coordination with the Special Investigation Unit.
• Establish and maintain appropriate claim reserves, adjusting as needed based on evolving claim circumstances.
• Negotiate settlements within authority levels and collaborate with legal counsel on litigated claims.
• Ensure Medicare compliance, including coordination of Medicare Set-Aside Trusts when applicable.
• Maintain thorough documentation and data accuracy in all claim files and systems.
• Provide timely updates on high-exposure or high-profile claims to management.
• Collaborate cross-functionally with Underwriting, Premium Consultation, and Loss Prevention teams.
• Deliver exceptional service to internal and external customers, including policyholders and producers.
• Participate in workflow improvement initiatives and support onboarding of new team members.
• Stay current with workers’ compensation laws and best practices through ongoing training and development.

Qualifications

• 2–4 years of claims handling experience, with a strong preference for workers’ compensation experience.
• Associate in Claims (AIC) designation preferred.
• Experience handling workers' compensation claims in MO, IA, NE, KS, AR, TN, and/or IL preferred.

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, 9 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