Senior Workers’ Comp Claims Specialist – Complex Caseload

MEM; Columbia Township (MO); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health plans (Medical, Dental, Vision)

401k retirement plan with employer-mix

Paid time off: holidays, PTO, parental

Job summary

MEM Insurance in Missouri seeks a seasoned Claims Representative to manage high-exposure workers’ compensation claims, oversee advanced medical case management, and craft tailored Return-to-Work plans. You’ll collaborate with vocational consultants, legal counsel, and internal teams to ensure compliance, negotiate settlements, and deliver exceptional service to our policyholders.

This position offers the opportunity to work independently while providing leadership on complex claims and

Qualifications

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

Claims handling

Negotiation

Leadership

Education

High School Diploma or equivalent

Bachelor's degree (preferred)

Job description

MEM Insurance in Missouri seeks a seasoned Claims Representative to manage high-exposure workers’ compensation claims, oversee advanced medical case management, and craft tailored Return-to-Work plans. You’ll collaborate with vocational consultants, legal counsel, and internal teams to ensure compliance, negotiate settlements, and deliver exceptional service to our policyholders.

This position offers the opportunity to work independently while providing leadership on complex claims and