Senior Workers’ Comp Claims Specialist

MEM MUTUAL INSURANCE; Columbia Township (MO); On-site; USD 48,000 - 72,000; Full time

Benefits offered by this job

Health plans

Life & disability benefits

401k match

Paid time off & holidays

Parental leave & adoption assistance

Job summary

MEM Insurance is seeking a detail-oriented Claims Representative to join our collaborative Claims team in Missouri. You will manage a caseload of moderately complex workers’ compensation claims, investigate, determine compensability, and coordinate with medical and legal partners to settle claims.

You will help develop RTW plans and ensure accurate disability benefits while upholding MEM guidelines. You will work with Nurse Case Managers, external vendors, and other departments to maintain data

Qualifications

• 2–4 years of claims handling experience; preference for workers’ compensation experience.
• Associate in Claims (AIC) designation preferred.
• Experience handling workers' compensation claims in MO, IA, NE, KS, AR, TN, and/or IL preferred.

Responsibilities

• Investigate and manage moderately complex workers’ compensation claims, ensuring compliance with state laws and MEM guidelines.
• Analyze statements and records to determine compensability and communicate findings to stakeholders.
• Collaborate with Nurse Case Managers and external vendors to oversee medical case management, including lifetime care planning and permanent restrictions.
• Develop tailored Return-to-Work (RTW) strategies with policyholders, ensuring accommodations align with medical restrictions.
• Calculate and issue accurate disability benefits in accordance with statutory requirements.
• Identify and investigate potential fraud or abuse in coordination with the Special Investigation Unit.
• Establish and maintain appropriate claim reserves, adjusting as needed based on evolving claim circumstances.
• Negotiate settlements within authority levels and collaborate with legal counsel on litigated claims.

Education

AIC designation

Job description

MEM Insurance is seeking a detail-oriented Claims Representative to join our collaborative Claims team in Missouri. You will manage a caseload of moderately complex workers’ compensation claims, investigate, determine compensability, and coordinate with medical and legal partners to settle claims.

You will help develop RTW plans and ensure accurate disability benefits while upholding MEM guidelines. You will work with Nurse Case Managers, external vendors, and other departments to maintain data