[Remote] Senior Claims Representative (Remote)

Note: The job is a remote job and is open to candidates in USA. MEM Insurance is seeking a Senior Claims Representative to join their Claims team, where you'll manage high-exposure workers’ compensation claims and lead investigations into coverage and fraud. This role involves collaborating across departments to drive strategic outcomes while mentoring junior adjusters and ensuring exceptional service and regulatory compliance. Responsibilities • Manage highly complex claims involving significant financial exposure, legal intricacies, and extended life cycles • Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations • Oversee medical case management for catastrophic injuries and lifetime care needs • Review and authorize large or complex medical bills, negotiating adjustments to control costs • Develop comprehensive RTW strategies in collaboration with policyholders, legal counsel, and vocational consultants • Ensure precision in benefit calculations for high-exposure claims, addressing tax and compliance risks • Strategically deploy investigative efforts aligned with broader claims strategy • Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit • Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery • Partner with legal teams to negotiate complex settlements and manage litigation processes • Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement • Identify opportunities for structured settlements and lead negotiations • Produce strategic reports on high-profile claims to guide management decisions • Maintain system data integrity and prepare claims for Corporate Plan of Action meetings • Lead cross-departmental efforts to improve claims handling and risk management • Resolve escalated customer service issues and support high-value accounts • Participate in workflow improvement initiatives and committees • Mentor and coach junior and intermediate adjusters • Review escalated claims and provide actionable feedback • Support workforce development and succession planning Skills • Bachelor's degree in business or related field preferred, or equivalent industry experience • 7–10 years of claims handling experience, with high exposure to Workers' Compensation • Valid driver's license required • Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain • Texas All-Lines license preferred Benefits • Health Plans: Medical, Dental, and Vision • Fertility benefits and fully paid preventative care • Adult orthodontia and other uncommon dental treatments • Fully Employer-Paid Life And Disability Benefits • Life Insurance – three times base salary • Accidental Death and Dismemberment • Short and Long-term Disability • Employee Wellness and Recognition Program • Employer-paid incentives for employees and their spouses • Flexible Spending Account and Dependent Care Options • Health Savings Account with Generous Employer Contribution • Generous PTO accruals • 11 Holidays and 4 Early Releases • 16 Hours of Volunteer Time Off • 20 Days of Paid Parental Leave (in addition to STD) • Marriage, Bereavement, and Jury Duty Leave Policies • Employee Assistance Programs • 401k Retirement Plan Including Employer Match and Profit Sharing • Adoption Assistance • Tuition Assistance Company Overview • MEM (formerly Missouri Employers Mutual and Previsor) is your Midwest regional workers compensation insurance partner. It was founded in 1995, and is headquartered in Columbia, Missouri, USA, with a workforce of 201-500 employees. Its website is Apply tot his job