Senior Claims Lead – Complex Workers’ Comp

MEM; United States; On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

Health, dental, vision

Life and disability benefits

401k with match

Paid time off

Parental leave

Wellness program

Tuition/Adoption assistance

Job summary

MEM Insurance is seeking a Senior Claims Representative to lead high-exposure workers’ compensation claims, investigate coverage and fraud, and partner across departments to drive strategic outcomes. You’ll be a key decision-maker, mentor to junior adjusters, and a catalyst for process improvements while ensuring service excellence and regulatory compliance.

You'll collaborate with policyholders, legal counsel, and medical teams on complex settlements, RTW strategies, subrogation, and Medicare

Qualifications

• Bachelor’s degree in business or related field preferred, or equivalent industry experience.
• 7-10 years of claims handling experience, with high exposure to Workers' Compensation.
• Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain.
• Valid driver’s license is required.

Responsibilities

• Manage highly complex workers' compensation claims with significant financial exposure.
• Lead investigations into coverage, fraud, and subrogation opportunities.
• Oversee medical case management for catastrophic injuries and lifetime care needs.
• Review and negotiate large or complex medical bills to control costs.
• Develop RTW strategies with policyholders, legal counsel, and vocational consultants.
• Provide strategic reporting for management and cross-departmental improvements.
• Mentor junior adjusters and support workforce development.

Skills

Mentoring

Regulatory compliance

Investigations

Negotiation

Education

Bachelor’s degree in business or related field

AIC/AIM/CPCU designation or ability to obtain

Job description

MEM Insurance is seeking a Senior Claims Representative to lead high-exposure workers’ compensation claims, investigate coverage and fraud, and partner across departments to drive strategic outcomes. You’ll be a key decision-maker, mentor to junior adjusters, and a catalyst for process improvements while ensuring service excellence and regulatory compliance.

You'll collaborate with policyholders, legal counsel, and medical teams on complex settlements, RTW strategies, subrogation, and Medicare