Senior Claims Leader - Remote (Workers’ Comp)

Mem Ins; Northern (KY); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health plans

Employer-mprovided life and disability

401k with match

Paid time off and holidays

Job summary

MEM Insurance seeks a Senior Claims Representative to join our Claims team in the United States. You will manage high-exposure workers’ compensation claims, lead investigations into coverage and fraud, and collaborate across departments to drive strategic outcomes.

You’ll mentor junior adjusters, ensure regulatory compliance, and participate in process improvements to enhance service for our policyholders and injured workers.

Qualifications

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

Responsibilities

• Manage highly complex claims involving significant financial exposure, legal intricacies, and extended life cycles.
• Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations.
• Oversee medical case management for catastrophic injuries and lifetime care needs.
• Review and authorize large or complex medical bills, negotiating adjustments to control costs.
• Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit.
• Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery.
• Partner with legal teams to negotiate complex settlements and manage litigation processes.
• Produce strategic reports on high-profile claims to guide management decisions.
• Mentor and coach junior and intermediate adjusters.

Skills

Claims handling

Mentoring

Regulatory compliance

Cross-department collaboration

Education

Bachelor’s degree in business or related field

AIC/AIM/CPCU designation preferred

Job description

MEM Insurance seeks a Senior Claims Representative to join our Claims team in the United States. You will manage high-exposure workers’ compensation claims, lead investigations into coverage and fraud, and collaborate across departments to drive strategic outcomes.

You’ll mentor junior adjusters, ensure regulatory compliance, and participate in process improvements to enhance service for our policyholders and injured workers.