Claims Specialist II, Workers’ Compensation

Mem Ins; Columbia Township (MO); Hybrid; USD 52,000 - 75,000; Full time

Benefits offered by this job

Health plans

Life and disability benefits

Generous PTO

401k with match

Tuition assistance

Job summary

MEM Insurance is seeking a Claims Representative to join our collaborative Claims team. You will manage moderately complex workers’ compensation claims and work with internal teams, policyholders, and external partners to investigate and settle claims.

You will analyze records for compensability, coordinate with Nurse Case Managers, and develop RTW plans that align with medical restrictions while protecting our policyholders’ financial integrity. Join us to make a meaningful impact.

Qualifications

• 2–4 years of claims handling experience, with a strong preference for workers’ compensation experience.
• Associate in Claims (AIC) designation preferred.
• Experience handling workers' compensation claims in MO, IA, NE, KS, AR, TN, and/or IL preferred.

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 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.

Skills

Claims handling

Analytical thinking

Investigation

Communication

Education

Associate in Claims (AIC)

Job description

MEM Insurance is seeking a Claims Representative to join our collaborative Claims team. You will manage moderately complex workers’ compensation claims and work with internal teams, policyholders, and external partners to investigate and settle claims.

You will analyze records for compensability, coordinate with Nurse Case Managers, and develop RTW plans that align with medical restrictions while protecting our policyholders’ financial integrity. Join us to make a meaningful impact.