Claims Representative II

Mem Ins; Columbia, Northern (SC, KY); Hybrid; USD 50,000 - 70,000; Full time

Benefits offered by this job

Health plans

Dental & Vision

Paid time off

401k with match

Tuition assistance

Job summary

MEM Insurance is seeking a Claims Representative to manage a caseload of moderately complex workers’ compensation claims and protect policyholder interests. You’ll investigate, analyze, and collaborate with medical teams to develop RTW plans and negotiate settlements within authority.

The role emphasizes accurate documentation and proactive service to insureds and producers. The position offers a collaborative environment with cross-functional partners, a focus on compliance with state laws, and

Qualifications

• 2-4 years of claims handling experience, strong preference for workers’ compensation experience.
• Experience handling claims in MO, IA, NE, KS, AR, TN, and/or IL preferred.

Responsibilities

• Investigate and manage moderately complex workers’ compensation claims.
• Analyze statements and records to determine compensability.
• Collaborate with Nurse Case Managers and external vendors for medical case management.
• Develop Return-to-Work strategies with policyholders.
• Calculate and issue accurate disability benefits under statutory requirements.
• Identify potential fraud or abuse in coordination with SIU.
• Maintain thorough documentation and data accuracy in claim files and systems.

Skills

Workers' compensation experience

Investigation

Negotiation

Collaboration

Job description

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.

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Essential Duties and 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.

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Qualifications

• 2-4 years of claims handling experience, with a strong preference for workers’ compensation experience.
• Experience handling claims in MO, IA, NE, KS, AR, TN, and/or IL preferred

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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.

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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.

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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, 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

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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.