Enable job alerts via email!

Litigation Specialist (Remote)

Mem Ins

Town of Texas (WI)

Remote

USD 80,000 - 100,000

Full time

2 days ago
Be an early applicant

Boost your interview chances

Create a job specific, tailored resume for higher success rate.

Job summary

A leading insurance company is seeking a Litigation Specialist to manage complex claims and provide expert guidance. This role involves directing litigation strategies, ensuring compliance with Medicare, and mentoring junior staff. The ideal candidate will have extensive experience in claims handling and a strong background in litigation management.

Benefits

Medical, Dental, and Vision Plans
Employer-Paid Life and Disability Benefits
Employee Wellness and Recognition Program
Flexible Spending Account
Health Savings Account
Generous PTO and Paid Parental Leave
401k Retirement Plan with employer match

Qualifications

  • 8+ years of claims handling experience required.
  • Experience in evaluating and negotiating settlements.

Responsibilities

  • Manage complex litigated claims across multiple jurisdictions.
  • Direct litigation strategy in collaboration with defense counsel.
  • Mentor less experienced claims representatives.

Skills

Litigation Strategy
Claims Management
Negotiation
Medicare Compliance

Education

Bachelor’s degree in business or related field

Job description

Are you driven to keep people safe? That’s what we do every day at MEM Insurance.

We’ve created a casual, values-driven work culture that’s making a positive impact on the way people live and work. This is a place where you can grow with confidence — because that’s what safety and success really mean to us.

SUMMARY:

The Litigation Specialist is an advanced-level position responsible for managing and resolving moderate to highly complex, high-exposure litigated claims involving significant financial, legal, and reputational risks. This role requires expertise in evaluating claims strategy, directing litigation in collaboration with defense counsel, and resolving issues such as Medicare compliance, future medical projections, and structured settlements. The Litigation Specialist independently develops, implements, and leads Settlement Day and Special Mediation strategies across multiple regions, coordinating with claims staff, counsel, and other stakeholders to achieve corporate closure goals. Acting as a resource and mentor, this position provides expert guidance to less experienced adjusters, contributes to strategic claim reviews, and ensures adherence to statutory requirements and company claims philosophy. The ability to manage a challenging caseload with minimal supervision, exercise sound judgment, and deliver quality outcomes is critical to success in this role. This position will work closely with defense attorneys, medical providers, and internal stakeholders to ensure efficient and fair claim handling.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Litigation File & Case Management
  1. Manage caseload of complex, high-exposure litigated claims across multiple jurisdictions, pursuant to department guidelines, with management-level authority. Caseload includes toxic exposure cases, claims involving permanent total disability (PTD) allegations, disputed/litigated fatality cases, and disputed/litigated coverage cases. Identify cases with possible allegations of enhanced benefits.
  2. Manage cases involving multiple employers and/or employment concerns. Identify cases with coverage concerns and collaborate with the Technical Services Unit to resolve conflict issues or cases involving civil liability.
  3. Direct litigation strategy and collaborate with counsel in the defense of assigned caseload. Determine if expert evaluations or vocational opinions are necessary for claims with PTD exposure.
  4. Identify and resolve all case issues, including future medical concerns, Medicare issues, and liens. Obtain future medical projections and Medicare Set-Aside proposals as necessary.
  5. Identify opportunities for structured settlements of indemnity and medical benefits. Work with counsel to determine exposure estimates and maintain accurate reserves as discovery progresses.
Settlement and Mediation
  • Solely responsible for achieving the Claims Department goal for Settlement Days and Special Mediation settings. Act as the educator and leader for these settings by coordinating schedules, encouraging participation, identifying appropriate cases, negotiating with multiple parties, and reporting results to management. Parties include claims representatives, defense counsel, plaintiff counsel, judges, second-injury fund representatives, injured workers, and mediators.
Medicare Compliance and Expertise
  • Serve as a specialist resource on Medicare issues across multiple claim regions. Determine when Medicare Set-Asides (MSAs) and CMS approvals are required, communicate with CMS and Medicare vendors on MSA proposals and Conditional Payments, and finalize settlements in compliance with Medicare guidelines.
  • Assist with questions regarding rated ages, annuity quotes, and professional administration of Medicare Set-Aside proposals.
Lifetime Medical Claims Management
  • Manage claims with open lifetime medical exposure, ensuring appropriate ongoing medical care while controlling costs.
  • Monitor long-term medical treatment plans and ensure medical necessity.
  • Negotiate cost-effective resolutions, including structured settlements where appropriate.
  • Collaborate with nurse case managers, medical providers, and other stakeholders to optimize care plans.
File Management and Reporting
  • Maintain a diary of potential file reassignments, prioritizing based on discovery status, case complexity, representative experience, and departmental staffing needs.
  • Present toxic exposure cases and cases with possible enhanced benefits in annual Enhanced Benefit Plan of Action Meetings. Provide legal plans of action, reserve recommendations, and resolution strategies, documenting file plans following the meetings.
Mentorship and Team Leadership
  • Identify opportunities to mentor and assist less experienced claims representatives, including collaboration on cases involving future medical issues, large exposures, and reserve recommendations.
  • Provide recommendations on litigation plans of action and the use of experts. Assist with conditional payment liens, psych allegations, assault cases, and catastrophic claims requiring home or vehicle modifications.
  • Provide expert analysis in monthly Plan of Action Meetings, contributing insights on medical status, legal strategy, reserve recommendations, and resolution strategies for complex files.
QUALIFICATIONS:
Education

Bachelor’s degree in business or related field preferred or a combination of industry work experience.

Designations/Certifications

Associate in Claims (AIC) or other insurance designation is preferred or the ability to obtain. AIM preferred.

Licenses

Texas - All Lines Preferred. A valid driver’s license is required.

Experience

8+ years of claims handling experience, including investigation, evaluating, and negotiating settlements of workers compensation claims.

  • Health Plans: Medical, Dental, and Vision
    • Our medical plan includes offerings such as fertility benefits and fully paid preventative care.
    • Our dental coverage includes adult orthodontia and other treatments.
  • Fully Employer-Paid Life and Disability Benefits
    • Life Insurance - three times base salary
    • Accidental Death and Dismemberment
    • Short and Long-term Disability
  • Employee Wellness and Recognition Program with employer-paid incentives for employees and spouses
  • Flexible Spending Account and Dependent Care options
  • Health Savings Account with employer contribution
  • Time Away from Work
    • Generous PTO, holidays, early releases, volunteer time off, paid parental leave, and leave policies
  • Employee Assistance Programs
  • 401k Retirement Plan with employer match and profit sharing
Get your free, confidential resume review.
or drag and drop a PDF, DOC, DOCX, ODT, or PAGES file up to 5MB.

Similar jobs

Senior Litigation Docketing Specialist

LHH

Town of Texas

Remote

USD 95.000 - 115.000

3 days ago
Be an early applicant

Litigation Counsel - (REMOTE)

eXp World Holdings

Oklahoma City

Remote

USD 80.000 - 120.000

8 days ago

Litigation Docket Specialist

Husch Blackwell

Texas

Remote

USD 54.000 - 105.000

Today
Be an early applicant

Senior Litigation Specialist

BERKLEY TECHNOLOGY SERVICES

City of Syracuse

Remote

USD 70.000 - 110.000

5 days ago
Be an early applicant

Senior Litigation Specialist

Berkley

City of Syracuse

Remote

USD 70.000 - 110.000

6 days ago
Be an early applicant

Sr. Counsel Employment & Litigation (Remote)

ThyssenKrupp North America

Chicago

Remote

USD 90.000 - 150.000

6 days ago
Be an early applicant

Litigation Moderate Claims Adjuster Sr Consultant - Remote (EST)

Allstate Northern Ireland Limited

Remote

USD 57.000 - 101.000

14 days ago

Sr. Counsel Employment & Litigation (Remote)

ThyssenKrupp Presta AG

Chicago

Remote

USD 90.000 - 150.000

8 days ago

Litigation Moderate Claims Adjuster Sr Consultant - Remote (EST)

Allstate Insurance

Illinois

Remote

USD 50.000 - 90.000

11 days ago