Workers' Compensation Claims Representative III (Remote)

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

Are you an experienced claims professional ready to take on complex cases and make a meaningful impact? MEM Insurance is seeking a seasoned Claims Representative to join our dynamic Claims team. In this role, you will manage a caseload of high-exposure workers’ compensation claims, oversee advanced medical case management, and develop 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 contributing to workflow improvements.

Essential Duties and 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.

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.

Company Culture and Values

At MEM Insurance, we are committed to our vision, mission, and values. We foster a culture of collaboration, integrity, and innovation. Our team is passionate about delivering exceptional service to our customers while supporting each other’s growth and success. We believe in accountability, continuous learning, and creating an environment where employees feel valued and empowered.

Diversity Statement

MEM Insurance is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We believe that varied perspectives drive innovation and strengthen our ability to serve our customers and communities.

Total Rewards Overview

• Health Plans: Medical, Dental, and Vision
  Includes fertility benefits, fully paid preventative care, and adult orthodontia.
• Employer-Paid Life and Disability Benefits:
  Life Insurance (3x base salary), AD&D, Short and Long-term Disability.
• Wellness and Recognition Program: Employer-paid incentives for employees and spouses.
• Flexible Spending Account and Dependent Care options
• Health Savings Account: Generous employer contribution.
• Time Away from Work:
  Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave.
• Employee Assistance Programs
• 401k Retirement Plan: Employer match and profit sharing.
• Adoption Assistance and Tuition Assistance

Notice Regarding Use of Artificial Intelligence

MEM may use artificial intelligence (AI) tools to more efficiently facilitate and assist in decisions involving recruitment, hiring, promotion, renewal of employment, selection for training or apprenticeship, discharge, discipline, tenure, or the terms, privileges, or conditions of employment. Any such use of AI tools will comply with all applicable laws.