Financial Claims Processor

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.

Manage complex workers’ compensation claims involving high financial exposure, sensitive issues, or extended life cycles.
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.
Provide mentorship and training to junior adjusters, supporting professional growth and team development.

High school diploma or equivalent required; bachelor’s degree preferred.
~ Associate in Claims (AIC) designation preferred.
~ 3–5 years of claims handling experience, primarily in Workers’ Compensation. 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. 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.

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.
Flexible Spending Account and Dependent Care options
Health Savings Account: Generous PTO, 9 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.