Claims Consultant

memployersmins; United States; Remote; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health plans (Medical, Dental, Vision)

Employer-paid Life & Disability

Wellness & Recognition program

401k with match

Adoption & Tuition Assistance

Generous PTO & Holidays

Employee Assistance Program

Job summary

MEM Insurance seeks a seasoned Claims Consultant to provide technical leadership for our most complex, high-exposure workers’ compensation claims. You will guide investigations, reserves, litigation strategies, and settlement decisions while coaching staff and shaping policies.

You will lead audits, reviews, and training efforts to elevate claim quality and outcomes, collaborating with leadership to drive best practices across the organization.

Qualifications

• Bachelor's degree in Business, Insurance, Risk Management, or a related field.
• AIC designation (claims) is preferred.
• SCLA designation preferred.
• CSRP designation preferred.
• Claims Adjusting License preferred.

Responsibilities

• Provide technical oversight and strategic direction on complex and high-exposure workers’ compensation claims, ensuring investigations, reserving, evaluation, litigation management, and settlement strategies.
• Conduct monthly Plan of Action (POA) meetings and claim reviews for high-exposure claims (exposures > $500,000) with guidance on strategy and reserves.
• Investigate, manage, and resolve complex coverage matters, including questionable coverage and no-coverage scenarios.
• Partner with claims leadership and coverage counsel to resolve disputes and litigation matters.
• Lead reviews on files with significant incurred values and provide recommendations for resolution.
• Lead CARE Reviews (Claims Audits) to evaluate claim quality and identify improvement opportunities.
• Analyze audit findings and trends to improve performance and consistency across claims.
• Deliver coaching and technical guidance to field claims professionals on coverage, determinations, and best practices.
• Support development and delivery of training programs for claims personnel.
• Provide oversight on Argonaut Insurance claim activities, including reviews, reserves, and audits.
• Research emerging issues to support expansion into new states and markets.
• Conduct Burn Rate Reviews to identify trends and risks for intervention.
• Collaborate with senior leadership to maintain policies, procedures, and best practices.
• Prepare reports and recommendations summarizing trends and opportunities across claims.
• Organize and prioritize work across multiple projects in a fast-paced environment.

Education

Bachelor's degree in Business, Insurance, Risk Management, or a related field

AIC (Associate in Claims) designation

SCLA (Senior Claims Law Associate) designation

CSRP (Certified Subrogation Recovery Professional) designation

Claims Adjusting License

Job description

Are you a highly experienced workers’ compensation claims professional who thrives on solving complex challenges, influencing outcomes, and developing others? MEM Insurance is seeking a Claims Consultant to provide technical leadership and oversight for our most complex, high-exposure claims. In this role, you will serve as a trusted advisor to claims leadership and field staff, helping ensure strong claim outcomes through effective case management, sound coverage analysis, strategic planning, and technical guidance.

As a key member of our Claims team, you will lead reviews of high-severity claims, conduct audits to identify best practices and opportunities for improvement, provide coaching and mentoring to claims professionals, and play an important role in shaping policies, procedures, and training initiatives. This position offers the opportunity to make a meaningful impact on both claim outcomes and the professional development of claims staff across the organization.

Essential Duties and Responsibilities

• Provide technical oversight and strategic direction on complex and high-exposure workers’ compensation claims, ensuring appropriate investigations, reserving, evaluation, litigation management, and settlement strategies.
• Conduct monthly Plan of Action (POA) meetings and claim reviews for high-exposure claims, generally involving exposures exceeding $500,000, while providing guidance regarding claim strategy, reserve adequacy, and critical claim management decisions.
• Investigate, manage, and resolve complex coverage matters, including questionable coverage claims, potential no-coverage scenarios, Employers Liability claims, and related litigation.
• Partner with claims leadership and coverage counsel to develop solutions for challenging coverage disputes and litigation matters.
• Conduct comprehensive claim reviews on files with significant incurred values and provide recommendations that support effective claim resolution and favorable outcomes.
• Lead CARE Reviews (Claims Audits) to evaluate claim quality, identify best practices, monitor operational performance, and uncover opportunities for improvement throughout the claims organization.
• Analyze audit findings and operational trends, providing actionable feedback and recommendations to claims leadership to improve performance and drive consistency.
• Deliver coaching, mentoring, and technical guidance to field claims professionals and managers on workers’ compensation coverage, compensability determinations, litigation management, and claim-handling best practices.
• Support the development and delivery of training programs for claims personnel, promoting continual learning, technical excellence, and professional growth.
• Provide technical oversight and consultation on Argonaut Insurance claim activities, including claim reviews, reserve evaluations, settlement authority reviews, audits, and special projects.
• Research emerging claim issues and develop jurisdiction‑specific training and resources to support business expansion into new states and markets.
• Conduct Burn Rate Reviews of open, high-exposure claims to ensure timely identification of trends, risks, and opportunities for intervention.
• Collaborate with senior claims leadership to develop, refine, and maintain claims policies, procedures, and operational best practices.
• Prepare reports, analyses, and recommendations for claims leadership, summarizing findings, trends, and opportunities across the claims operation.
• Organize and prioritize work effectively while managing multiple projects, assignments, and deadlines in a fast‑paced environment.

Qualifications

• Bachelor's degree in Business, Insurance, Risk Management, or a related field preferred.
• AIC (Associate in Claims) designation preferred.
• SCLA (Senior Claims Law Associate) designation preferred.
• CSRP (Certified Subrogation Recovery Professional) designation preferred.
• Claims Adjusting License preferred.
• Ten or more years of progressively responsible claims experience, including significant workers’ compensation and commercial liability claims experience.
• Extensive experience managing complex litigation and high-exposure claims strongly preferred.
• Demonstrated experience providing guidance, consultation, or leadership to claims professionals and management teams.

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.

Connection and Belonging

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 VisionIncludes 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, 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 IntelligenceMEM 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.