Workers' Compensation Claims Representative (Remote)

MEM
Springfield, IL
Category Human Resources
Remote
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.

Requirements

  • 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.

Benefits

  • 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
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