Claims Adjuster

MEM; Missouri; On-site; USD 75,000 - 105,000; Full time

Benefits offered by this job

Health plans

Dental and Vision

Life and Disability Insurance

401k plan

Paid holidays

PTO

Employee assistance programs

Job summary

MEM Insurance in Missouri seeks an experienced Claims Representative III to manage high-exposure workers’ compensation claims and lead complex medical case management. You will develop tailored Return-to-Work plans and collaborate with vocational consultants, legal counsel, and internal teams to ensure settlements and service excellence.

You will mentor junior adjusters, oversee reserves, and contribute to workflow improvements while maintaining compliance with state statutes and MEM guidelines.

Qualifications

• Experience handling complex workers’ compensation claims.
• Knowledge of state statutes and regulatory compliance.
• Ability to develop Return-to-Work plans and coordinate with specialists.

Responsibilities

• Manage complex workers’ compensation claims with high financial exposure and long life cycles.
• Investigate coverage and compensability with thorough documentation.
• Oversee advanced medical case management with Nurse Case Managers and vendors.
• Develop Return-to-Work plans for high-risk claims with vocational and legal teams.
• Identify fraud and subrogation opportunities with the Special Investigation Unit.
• Establish and maintain claim reserves within authority levels.
• Evaluate and negotiate settlements, including Medicare considerations.
• Collaborate with legal counsel on litigation and MEM guidelines.
• Maintain accurate system data and prepare management reports.

Skills

Claims handling

Workers’ Compensation

Case management

Negotiation

Leadership mentorship

Education

High school diploma or equivalent

Bachelor’s degree preferred

Job description

Are you an experienced claims professional ready to take on complex cases and make a meaningful impact? MEM Insurance is seeking a seasoned Claims Representative III to join our dynamic Claims team. In this role, you will manage a caseload of high-exposure workers’ compensation claims, oversee advanced medical case management, and develop tailored Return-to-Work plans. You’ll collaborate with vocational consultants, legal counsel, and internal teams to ensure compliance, negotiate settlements, and deliver exceptional service to our policyholders. This position offers the opportunity to work independently while providing leadership on complex claims and contributing to workflow improvements.

• 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.
• Valid driver’s license required; Texas-All Lines license preferred.
• 3–5 years of claims handling experience, primarily in Workers’ Compensation. Missouri experience preferred.

Company Culture And Values

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.

Diversity Statement

MEM Insurance is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We believe that varied perspectives drive innovation and strengthen our ability to serve our customers and communities.

Total Rewards Overview

• 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
• 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

Notice Regarding Use of Artificial Intelligence

MEM may use artificial intelligence (AI) tools to more efficiently facilitate and assist in decisions involving recruitment, hiring, promotion, renewal of employment, selection for training or apprenticeship, discharge, discipline, tenure, or the terms, privileges, or conditions of employment. Any such use of AI tools will comply with all applicable laws.