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M
MEM - Missouri Employers Mutual
Workers Compensation Claims Representative III (Remote)
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What they do
A Claims Representative accepts and reviews applications for insurance and provides information to insurance agents. Assists insurance customers, answers questions and processes requests to change or cancel policies. May assist with insurance claims that are disputed, review claims and policy coverage and help to negotiate agreements between customers and an insurance company.
$51,589 / year median in the U.S.
+2% projected growth
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.