Senior Workers' Comp Claims Leader

Clear Destination Inc.; United States; Remote; USD 85,000 - 130,000; Full time

Benefits offered by this job

Health plans

Life & Disability

Wellness program

FSA

HSA

Paid time off

401k retirement plan

Education assistance

Job summary

MEM Insurance is seeking a Senior Claims Representative to manage high-exposure workers’ compensation claims, lead investigations into coverage and fraud, and mentor junior adjusters. In this pivotal role, you’ll collaborate across departments to drive strategic outcomes, review complex medical bills, oversee Medicare compliance initiatives, and negotiate settlements with legal teams.

You will champion process improvements, ensure regulatory compliance, and deliver exceptional service to

Qualifications

• Bachelor’s degree or equivalent industry experience.
• 7–10 years of claims handling experience, with high exposure to Workers’ Compensation.
• AIC/AIM/CPCU designation preferred or ability to obtain.
• Texas All-Lines license preferred.
• 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.
• Develop comprehensive RTW strategies in collaboration with policyholders, legal counsel, and vocational consultants.
• Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit.
• Negotiate complex settlements and manage litigation processes.
• Identify opportunities for structured settlements and lead negotiations.

Skills

High exposure claims handling

Investigations

Regulatory compliance

Mentoring

Education

Bachelor’s degree in business or related field

Associate in Claims (AIC), AIM, or CPCU

Texas All-Lines license

Job description

MEM Insurance is seeking a Senior Claims Representative to manage high-exposure workers’ compensation claims, lead investigations into coverage and fraud, and mentor junior adjusters. In this pivotal role, you’ll collaborate across departments to drive strategic outcomes, review complex medical bills, oversee Medicare compliance initiatives, and negotiate settlements with legal teams.

You will champion process improvements, ensure regulatory compliance, and deliver exceptional service to