Workers' Compensation Claims Representative III (Remote)

About the role

MEM Insurance is seeking a seasoned Claims Representative to join our dynamic Claims team. The ideal candidate will manage complex workers’ compensation claims, oversee advanced medical case management, and develop tailored Return-to-Work plans.

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.

Qualifications

• 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.