Claims Representative (Remote)

Are you a detail-oriented professional with a passion for helping others and navigating complex situations? MEM Insurance is seeking a Claims Representative to join our collaborative and mission-driven Claims team. In this role, you’ll manage a caseload of moderately complex workers’ compensation claims, ensuring quality care for injured workers while protecting the financial integrity of our policyholders. You’ll work closely with internal teams, policyholders, and external partners to investigate claims, develop return-to-work strategies, and negotiate fair settlements. If you thrive in a fast-paced environment and are committed to making a meaningful impact, we’d love to hear from you. Essential Duties and Responsibilities • Investigate and manage moderately complex workers’ compensation claims, ensuring compliance with state laws and MEM guidelines. • Analyze statements and records to determine compensability and communicate findings to stakeholders. • Collaborate with Nurse Case Managers and external vendors to oversee medical case management, including lifetime care planning and permanent restrictions. • Develop tailored Return-to-Work (RTW) strategies in partnership with policyholders, ensuring accommodations align with medical restrictions. • Calculate and issue accurate disability benefits in accordance with statutory requirements. • Identify and investigate potential fraud or abuse in coordination with the Special Investigation Unit. • Establish and maintain appropriate claim reserves, adjusting as needed based on evolving claim circumstances. • Negotiate settlements within authority levels and collaborate with legal counsel on litigated claims. • Ensure Medicare compliance, including coordination of Medicare Set-Aside Trusts when applicable. • Maintain thorough documentation and data accuracy in all claim files and systems. • Provide timely updates on high-exposure or high-profile claims to management. • Collaborate cross-functionally with Underwriting, Premium Consultation, and Loss Prevention teams. • Deliver exceptional service to internal and external customers, including policyholders and producers. • Participate in workflow improvement initiatives and support onboarding of new team members. • Stay current with workers’ compensation laws and best practices through ongoing training and development. Qualifications • 2–4 years of claims handling experience, with a strong preference for workers’ compensation experience. • Associate in Claims (AIC) designation preferred. • Texas All-Lines Adjuster License preferred. Company Culture and ValuesAt MEM Insurance, we live our values every day. We believe in doing the right thing, putting people first, and delivering exceptional service. Our culture is built on trust, teamwork, and a shared commitment to excellence. We support our employees with meaningful work, opportunities for growth, and a workplace where everyone belongs. We are proud to be an equal opportunity employer. MEM Insurance celebrates diversity and is committed to creating an inclusive environment for all employees. We welcome applicants of all backgrounds and experiences. Total Rewards OverviewWe care deeply about the well-being of our employees and their families. That’s why we offer a comprehensive Total Rewards package that supports your health, financial security, and work-life balance: Health Plans: Medical, Dental, and Vision • Medical plan includes fertility benefits and fully paid preventative care • Dental coverage includes adult orthodontia and other uncommon treatments Fully Employer-Paid Life and Disability Benefits • Life Insurance – three times base salary • Accidental Death and Dismemberment • Short and Long-term Disability Wellness and Recognition • Employee Wellness and Recognition Program with employer-paid incentives for employees and spouses Flexible Spending and Savings • Flexible Spending Account and Dependent Care options • Health Savings Account with generous employer contribution Time Away from Work • 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 Additional Benefits • Employee Assistance Programs • 401(k) Retirement Plan with employer match and profit sharing • Adoption Assistance • Tuition Assistance Join MEM Insurance and take the next step in your claims career with a company that values your expertise, your growth, and your well-being. Apply today!