Workers' Compensation Claims Representative

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.RequirementsManage 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.BenefitsHealth Plans: Medical, Dental, and VisionIncludes 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 optionsHealth 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 Programs401k Retirement Plan: Employer match and profit sharing.Adoption Assistance and Tuition AssistanceOriginally posted on Himalayas