Senior Workers' Comp Claims Lead: Complex, High-Exposure

Mem Ins; Northern (KY); Hybrid; USD 52,000 - 78,000; Full time

Benefits offered by this job

Health Plans

Life and Disability Benefits

Wellness Program

401k Matching

Tuition Assistance

Paid Holidays

Job summary

MEM Insurance is seeking an experienced Claims Representative to manage complex, high‑exposure workers’ compensation claims and oversee advanced medical case management. You will develop Return‑to‑Work plans and collaborate with vocational consultants, legal counsel, and internal teams to ensure compliance and settlements.

The role offers independence with leadership on complex claims, opportunities to contribute to workflow improvements, and mentorship to junior adjusters.

Qualifications

• 3–5 years of claims handling experience, primarily in Workers’ Compensation.
• Missouri experience preferred.
• Texas-All Lines license preferred.
• Bachelor’s degree preferred.

Responsibilities

• Manage complex workers’ compensation claims with high financial exposure.
• Investigate coverage and compensability with thorough documentation and compliance.
• Oversee advanced medical case management with Nurse Case Managers and external vendors.
• Develop and implement Return-to-Work plans for high-risk claims in collaboration with vocational consultants and legal counsel.
• Identify fraud and subrogation opportunities with the Special Investigation Unit.
• Establish and maintain accurate claim reserves within authority levels.

Skills

Claims handling

Workers’ compensation

High exposure claims

Education

High school diploma or equivalent

Associate in Claims (AIC) designation

Bachelor’s degree preferred

Tools

Texas All Lines license

Job description

MEM Insurance is seeking an experienced Claims Representative to manage complex, high‑exposure workers’ compensation claims and oversee advanced medical case management. You will develop Return‑to‑Work plans and collaborate with vocational consultants, legal counsel, and internal teams to ensure compliance and settlements.

The role offers independence with leadership on complex claims, opportunities to contribute to workflow improvements, and mentorship to junior adjusters.