Associate Claims Representative (Remote)
Are you an organized, relationship driven professional with a passion for helping people navigate important moments in their recovery? MEM Insurance is looking for an Associate Claims Representative to join our dedicated Claims team. In this role, you will independently manage a caseload of workers’ compensation claims—investigating coverage and compensability, coordinating medical care, managing disability and return to work processes, and supporting fair, well-documented claim resolutions.
You’ll work closely with medical providers, policyholders, attorneys, and internal partners to ensure injured workers receive quality care while also protecting the financial well being of our policyholders. This is a professional-level role where you’ll balance analytical decision-making with compassionate customer service—helping people during some of their most challenging times.
Essential Duties and Responsibilities
Claims Investigation, Evaluation & Administration
• Conduct thorough investigations of workers’ compensation claims, including coverage analysis, compensability decisions, and collection of statements and documentation.
• Identify coverage concerns, subcontractor issues, or other complexities and escalate when appropriate.
• Maintain well organized claim files with clear documentation, action plans, and timely updates.
• Establish, monitor, and adjust reserves to ensure accuracy and alignment with corporate expectations.
• Manage claims from initial report through final disposition, prioritizing workload to meet quality and productivity standards.
Medical & Disability Management
• Oversee the medical aspects of claims, ensuring injured workers receive appropriate, cost effective treatment.
• Collaborate with network providers, Nurse Case Management, Utilization Management, and specialists to guide care decisions.
• Review and process medical bills with accuracy and timeliness.
• Secure wage statements, calculate disability benefits correctly, and ensure payments follow statutory requirements.
• Manage Return to Work efforts, educating policyholders on light-duty options and helping employees resume safe, meaningful work.
Fraud Prevention, Subrogation & Loss Recovery
• Identify potential fraud indicators and collaborate with the Special Investigations Unit as needed.
• Investigate subrogation opportunities and document third-party liability to maximize recovery.
• Recognize when field visits or surveillance may be beneficial and coordinate those activities responsibly.
Claim Resolution, Negotiation & Legal Collaboration
• Obtain required disability ratings and evaluate settlement options within authority limits.
• Collaborate with internal and external counsel to execute legal strategy, review legal bills, and ensure litigation guidelines are followed.
• Address Medicare exposure appropriately, securing Medicare Set-Asides when required.
• Identify opportunities for structured settlements.
Reporting, Communication & Cross Functional Partnership
• Communicate claim status to policyholders, producers, and internal stakeholders with professionalism and clarity.
• Provide claim updates on high profile or high-dollar cases as requested.
• Partner with Underwriting, Premium Consultation, and Loss Prevention on risk concerns and claim trends.
• Support team members when colleagues are out of office.
Professional Development & Mentorship
• Engage in ongoing learning to stay current with workers’ compensation laws, regulations, and industry practices.
• Assist in onboarding and supporting new Claims team members.
Qualifications
• Education: High school diploma or equivalent experience required; bachelor’s degree preferred.
• Experience: 1–2 years of claims handling experience with exposure to workers’ compensation preferred.
• Licenses:
• Valid driver’s license required
• Certifications: AIC or other insurance designations 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.
Total Rewards Overview
• 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
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. Any such use of AI tools will comply with all applicable laws.
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You’ll work closely with medical providers, policyholders, attorneys, and internal partners to ensure injured workers receive quality care while also protecting the financial well being of our policyholders. This is a professional-level role where you’ll balance analytical decision-making with compassionate customer service—helping people during some of their most challenging times.
Essential Duties and Responsibilities
Claims Investigation, Evaluation & Administration
• Conduct thorough investigations of workers’ compensation claims, including coverage analysis, compensability decisions, and collection of statements and documentation.
• Identify coverage concerns, subcontractor issues, or other complexities and escalate when appropriate.
• Maintain well organized claim files with clear documentation, action plans, and timely updates.
• Establish, monitor, and adjust reserves to ensure accuracy and alignment with corporate expectations.
• Manage claims from initial report through final disposition, prioritizing workload to meet quality and productivity standards.
Medical & Disability Management
• Oversee the medical aspects of claims, ensuring injured workers receive appropriate, cost effective treatment.
• Collaborate with network providers, Nurse Case Management, Utilization Management, and specialists to guide care decisions.
• Review and process medical bills with accuracy and timeliness.
• Secure wage statements, calculate disability benefits correctly, and ensure payments follow statutory requirements.
• Manage Return to Work efforts, educating policyholders on light-duty options and helping employees resume safe, meaningful work.
Fraud Prevention, Subrogation & Loss Recovery
• Identify potential fraud indicators and collaborate with the Special Investigations Unit as needed.
• Investigate subrogation opportunities and document third-party liability to maximize recovery.
• Recognize when field visits or surveillance may be beneficial and coordinate those activities responsibly.
Claim Resolution, Negotiation & Legal Collaboration
• Obtain required disability ratings and evaluate settlement options within authority limits.
• Collaborate with internal and external counsel to execute legal strategy, review legal bills, and ensure litigation guidelines are followed.
• Address Medicare exposure appropriately, securing Medicare Set-Asides when required.
• Identify opportunities for structured settlements.
Reporting, Communication & Cross Functional Partnership
• Communicate claim status to policyholders, producers, and internal stakeholders with professionalism and clarity.
• Provide claim updates on high profile or high-dollar cases as requested.
• Partner with Underwriting, Premium Consultation, and Loss Prevention on risk concerns and claim trends.
• Support team members when colleagues are out of office.
Professional Development & Mentorship
• Engage in ongoing learning to stay current with workers’ compensation laws, regulations, and industry practices.
• Assist in onboarding and supporting new Claims team members.
Qualifications
• Education: High school diploma or equivalent experience required; bachelor’s degree preferred.
• Experience: 1–2 years of claims handling experience with exposure to workers’ compensation preferred.
• Licenses:
• Valid driver’s license required
• Certifications: AIC or other insurance designations 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.
Total Rewards Overview
• 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
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. Any such use of AI tools will comply with all applicable laws.
Apply tot his job
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