Senior Workers' Comp Claims Consultant & Coach

memployersmins; United States; Remote; USD 120,000 - 180,000; Full time

Benefits offered by this job

Health plans (Medical, Dental, Vision)

Employer-paid Life & Disability

Wellness & Recognition program

401k with match

Adoption & Tuition Assistance

Generous PTO & Holidays

Employee Assistance Program

Job summary

MEM Insurance seeks a seasoned Claims Consultant to provide technical leadership for our most complex, high-exposure workers’ compensation claims. You will guide investigations, reserves, litigation strategies, and settlement decisions while coaching staff and shaping policies.

You will lead audits, reviews, and training efforts to elevate claim quality and outcomes, collaborating with leadership to drive best practices across the organization.

Qualifications

• Bachelor's degree in Business, Insurance, Risk Management, or a related field.
• AIC designation (claims) is preferred.
• SCLA designation preferred.
• CSRP designation preferred.
• Claims Adjusting License preferred.

Responsibilities

• Provide technical oversight and strategic direction on complex and high-exposure workers’ compensation claims, ensuring investigations, reserving, evaluation, litigation management, and settlement strategies.
• Conduct monthly Plan of Action (POA) meetings and claim reviews for high-exposure claims (exposures > $500,000) with guidance on strategy and reserves.
• Investigate, manage, and resolve complex coverage matters, including questionable coverage and no-coverage scenarios.
• Partner with claims leadership and coverage counsel to resolve disputes and litigation matters.
• Lead reviews on files with significant incurred values and provide recommendations for resolution.
• Lead CARE Reviews (Claims Audits) to evaluate claim quality and identify improvement opportunities.
• Analyze audit findings and trends to improve performance and consistency across claims.
• Deliver coaching and technical guidance to field claims professionals on coverage, determinations, and best practices.
• Support development and delivery of training programs for claims personnel.
• Provide oversight on Argonaut Insurance claim activities, including reviews, reserves, and audits.
• Research emerging issues to support expansion into new states and markets.
• Conduct Burn Rate Reviews to identify trends and risks for intervention.
• Collaborate with senior leadership to maintain policies, procedures, and best practices.
• Prepare reports and recommendations summarizing trends and opportunities across claims.
• Organize and prioritize work across multiple projects in a fast-paced environment.

Education

Bachelor's degree in Business, Insurance, Risk Management, or a related field

AIC (Associate in Claims) designation

SCLA (Senior Claims Law Associate) designation

CSRP (Certified Subrogation Recovery Professional) designation

Claims Adjusting License

Job description

MEM Insurance seeks a seasoned Claims Consultant to provide technical leadership for our most complex, high-exposure workers’ compensation claims. You will guide investigations, reserves, litigation strategies, and settlement decisions while coaching staff and shaping policies.

You will lead audits, reviews, and training efforts to elevate claim quality and outcomes, collaborating with leadership to drive best practices across the organization.