Senior Workers' Comp Claims Lead with Return-to-Work

Mem Ins; Columbia Township (MO); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health Plans: Medical, Dental, Vision

Employer-Paid Life and Disability

401k Retirement Plan

Job summary

MEM Insurance is seeking a seasoned Claims Representative to manage high-exposure workers’ compensation claims and oversee advanced medical case management. You will coordinate with vocational consultants, legal counsel, and internal teams to ensure compliance, negotiate settlements, and deliver exceptional service to policyholders.

You will also mentor junior adjusters, contribute to workflow improvements, and lead cross-department collaboration while maintaining claim reserves and timely

Qualifications

• High school diploma or equivalent required; bachelor’s degree preferred.
• Associate in Claims (AIC) designation preferred.
• Valid driver’s license required; Texas-All Lines license preferred.
• 3–5 years of claims handling experience, primarily in Workers’ Compensation. Missouri experience preferred.

Responsibilities

• Manage complex workers’ compensation claims involving high financial exposure, sensitive issues, or extended life cycles.
• Investigate coverage and compensability, ensuring thorough documentation and compliance with state statutes.
• Oversee advanced medical case management, including coordination with Nurse Case Managers and external vendors.
• Develop and implement Return-to-Work plans for high-risk claims, collaborating with vocational consultants and legal counsel.
• Identify and investigate potential fraud and subrogation opportunities, partnering with the Special Investigation Unit.
• Establish and maintain accurate claim reserves within authority levels, ensuring timely responsiveness to changing circumstances.
• Evaluate and negotiate settlements within approved authority levels, including structured settlements and Medicare compliance.
• Collaborate with legal counsel to manage litigation and ensure adherence to MEM guidelines.
• Maintain accurate system data and prepare reports for management on high-profile claims.
• Foster cross-departmental collaboration with Underwriting, Premium Consultation, and Loss Prevention.
• Provide mentorship and training to junior adjusters, supporting professional growth and team development.

Skills

Workers' compensation experience

Claim negotiation

Mentoring others

Education

High school diploma or equivalent

Bachelor's degree preferred

Tools

AIC designation?

Job description

MEM Insurance is seeking a seasoned Claims Representative to manage high-exposure workers’ compensation claims and oversee advanced medical case management. You will coordinate with vocational consultants, legal counsel, and internal teams to ensure compliance, negotiate settlements, and deliver exceptional service to policyholders.

You will also mentor junior adjusters, contribute to workflow improvements, and lead cross-department collaboration while maintaining claim reserves and timely