Claims Specialist II, Workers' Comp

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

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