Senior Claims Representative
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Senior Claims Representative managing high-exposure workers’ compensation claims for MEM Insurance. Leading investigations, settlements, compliance, reporting, and adjuster development.
Responsibilities:
- Manage highly complex workers’ compensation claims involving significant financial exposure, legal intricacies, and extended life cycles
- Conduct advanced investigations into coverage, compensability, fraud, and loss prevention
- Oversee medical case management for catastrophic injuries and lifetime care needs
- Review and authorize large or complex medical bills and negotiate adjustments to control costs
- Develop return-to-work strategies with policyholders, legal counsel, and vocational consultants
- Ensure accurate benefit calculations for high-exposure claims
- Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery
- Partner with legal teams on complex settlements and litigation processes
- Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement
- Identify structured-settlement opportunities and lead negotiations
- Produce strategic reports on high-profile claims and prepare claims for Corporate Plan of Action meetings
- Lead cross-departmental claims-handling and risk-management improvements
- 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
Requirements:
- 7–10 years of claims handling experience, with high exposure to Workers’ Compensation
- Bachelor’s degree in business or related field preferred, or equivalent industry experience
- Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain
- Texas All-Lines license preferred
- Valid driver’s license required
- Ability to manage highly complex, high-exposure workers’ compensation claims
- Experience conducting advanced coverage, compensability, fraud, subrogation, and loss-prevention investigations
- Knowledge of nuanced statutory interpretations and regulatory compliance
- Experience overseeing medical case management for catastrophic injuries and lifetime care needs
- Experience reviewing and authorizing large or complex medical bills and negotiating adjustments
- Experience developing return-to-work strategies and calculating benefits while addressing tax and compliance risks
- Experience negotiating complex settlements, managing litigation processes, Medicare Set-Asides, and CMS engagement
- Ability to produce strategic claims reports and maintain system data integrity
- Ability to mentor and coach junior and intermediate adjusters
Benefits:
- Medical, dental, and vision health plans, including fertility benefits, fully paid preventive care, and adult orthodontia
- Employer-paid life insurance equal to 3x base salary
- Employer-paid AD&D insurance
- Employer-paid short- and long-term disability
- Employer-paid wellness and recognition incentives for employees and spouses
- Flexible Spending Account and dependent care options
- Health Savings Account with generous employer contribution
- Generous paid time off
- 11 holidays and 4 early releases
- 16 hours volunteer time off
- 20 days paid parental leave
- Marriage, bereavement, and jury duty leave
- Employee Assistance Programs
- 401(k) retirement plan with employer match and profit sharing
- Adoption assistance
- Tuition assistance
Similar Jobs
Property Claims Representative
Property Claims Representative investigating and resolving property claims for Preferred Mutual Insurance. Evaluating coverage, liability, damages, reserves, and subrogation opportunities.
Commercial Auto Claims Representative – Pre-Suit Bodily Injury
Commercial auto claims adjuster handling pre-suit bodily injury investigations, coverage analysis, and injury valuation. Resolving claims remotely for Berkshire Hathaway’s biBerk commercial insurance business.
Claims Coordinator
Claims Coordinator processing healthcare claims for Machinify’s AI-powered health plan platform. Reviewing documents, entering claim data, routing files, and ensuring HIPAA-compliant processing.
Auto Commercial Claims Adjuster
Commercial claims adjuster managing transportation physical damage claims for Reserv’s AI-driven insurtech platform. Investigating losses, negotiating settlements, and coordinating repairs, recovery, and total-loss outcomes.
Senior Claims Specialist
Senior Claims Specialist managing complex workers’ compensation claims for CorVel, a national risk-management solutions provider. Investigating claims, managing litigation and recoveries, and negotiating outcomes remotely in California.
Executive Claims Specialist, Bodily Injury
Executive Claims Specialist overseeing TPA-managed bodily injury, PIP, and property damage rideshare claims. Controlling litigation costs and improving claims outcomes for specialty insurer Crum & Forster.
Executive Claims Specialist, PIP
Executive Claims Specialist providing technical oversight of PIP/no-fault claims for Crum & Forster’s specialty insurance programs. Auditing TPA claim handling, evaluating complex exposures and guiding litigation, arbitration and compliance.
Senior Claims Analyst
Senior Claims Analyst handling complex casualty and environmental insurance claims for One80 Intermediaries. Investigating coverage, managing litigation, and resolving claims remotely in Massachusetts.
Senior Workers Comp Claims Specialist
Senior Workers’ Compensation Claims Specialist managing complex California claims for National Interstate, a commercial transportation insurer. Fully remote from the USA, handling investigations, settlements, reserves, and litigation matters.
Claims Adjuster – Commercial Auto Claims
Claims Adjuster managing complex commercial auto, bodily injury, and physical damage claims. Supporting a world-class asset-based carrier’s safety, compliance, litigation, and vendor processes.
Senior Claims Representative – Transportation
Senior claims representative managing complex commercial auto claims for Berkley Small Business Solutions. Handling coverage, investigations, reserves, settlements, vendors, and mentoring across jurisdictions.
Cargo Claims Specialist
Cargo Claims Specialist processing cargo claims for Trinity Logistics’ freight operations. Providing solutions and customer-carrier claims expertise while working remotely.
Claims Examiner II
Claims Examiner II adjudicating healthcare claims for HealthEdge’s health insurance technology platform. Reviewing coding, coverage criteria, and system edits while mentoring team members.
Claims Examiner II
Claims Examiner II adjudicating healthcare claims for HealthEdge’s health insurance technology platform. Reviewing coding, coverage criteria, and payment accuracy while mentoring team members.
Claims Examiner – Workers Compensation, OR Cert Preferred
Remote workers compensation claims examiner adjudicating complex Oregon claims for Sedgwick. Investigating exposures, negotiating settlements, and communicating claim activity with clients and claimants.
Liability Claims Adjuster – Premises, Auto, Bodily Injury
Liability Claims Adjuster investigating and resolving auto and general liability claims for CCMSI, a third-party administrator. Managing bodily injury, premises, litigation, reserves, and settlements remotely.
Third Party Liability Claims Specialist
Third Party Liability Claims Specialist reviewing litigation accounts, liens, and settlements. Supporting Revecore’s hospital revenue recovery services through insurance and attorney coordination.
Claims Associate – Roofing, Property Claims
Remote Claims Associate coordinating inspections, dispatch, and communications for Hancock Claims Consultants’ residential and commercial property claims. Supporting fast-paced catastrophe events and policyholder service.
Crop Claims Representative, Northwest North Dakota
Crop claims representative assessing agricultural losses and settlements for Great American Insurance. Fully remote in Northwest North Dakota, with field inspections and up to 40% territory travel.
Crop Claims Representative
Remote crop claims representative evaluating agricultural claims for Great American Insurance in Eastern South Dakota. Investigating fields, determining settlements, and traveling up to 40% within the territory.