Claim Specialist III

Claim Specialist III

Remote

Candidates must have GA, VA, TN claims experience.

The Claim Specialist III investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.

Principal duties and responsibilities include:

• Communicating with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure.
• Administering the delivery of timely, appropriate and accurate indemnity and medical benefits.
• Evaluating claim exposure, negotiating and resolving claims. Working closely with defense counsel on litigated cases and attending mediation, arbitration, and hearings, as necessary.
• Working closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.
• Maintaining quality claim files in accordance with appropriate best practices, and other company procedures.
• Implementing Managed Care strategies, coordinating rehabilitation or medical management, processing bills, reviewing all mail through Image Right, and monitoring progress as appropriate.
• Interacting with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate.
• Serving as a mentor and helping prepare/train the less experienced Claim Department representatives.
• Keeping up-to-date on State laws and Company procedures relating to various claims; educating injured worker and/or insured on same.
• Preparing and presenting files for Agent/Broker Reviews and Insured File Review.
• Understanding medical terminology and standard medical procedures as they pertain to worker's compensation, U.S. Longshoreman's and Jones Act claims.
• Participating in in-house and outside training programs to keep up-to-date on relevant issues/topics.
• Maintaining a working knowledge of all computer systems currently in use.
• Traveling throughout States as required to handle claims inventory assigned.
• Continuing education in claims through Associate in Claims or Claims Law (AEI) courses.

Minimum knowledge, skills and abilities include:

• Three years of workers' compensation lost time and medical only claim handling experience preferred.
• Bachelor's degree preferred.
• Computer skills, Word, Excel and Image Right preferred.
• Must have a valid driver's license.
• Strong attention to detail and strong communication skills both verbal and written.
• Adaptable/flexible and self-directed with the ability to manage time, multiple priorities and other resources wisely.
• Must have the ability to work effectively with other organizational team members.

Our comprehensive benefits package includes all traditional offerings such as:

• Health Insurance options, Dental Insurance options and Vision Insurance
• Employee Life Insurance/AD&D and Dependent Life Insurance options
• Short-term & Long-term Disability
• Health Savings Account with potential employer match
• Flexible Medical and Dependent Care Account
• Accident Insurance
• Critical Illness Insurance
• Employee Assistance Program
• Legal/Identify Theft Insurance options
• Long Term Care Insurance
• Pet Insurance
• 401 (k) Retirement Plan with match up to 6%, plus annual bonus based on individual & company performance.
• 5 weeks of Paid Time Off (PTO)
• 11 paid holidays

We also offer other benefits to help foster a healthy, balanced lifestyle such as:

• Flextime schedules
• Paid Parental Leave
• Student loan paydown and refinancing assistance
• Educational assistance for job related courses, seminars, certifications or degrees
• One paid day every year to volunteer for your non-profit of choice
• Sit-Stand desks & daily stretch breaks

MEMIC is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, age, disability, genetics, gender identity, veteran's status, sexual orientation, or any other characteristic protected by law.