Claim Specialist IV
SC & TN Jurisdictions
The Claim Specialist IV investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. (Supervisor will determine actual individual authority up to the stated maximum). Conducts training classes (including research and position papers) for less experienced Claim Department Representatives. 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
* Communicates 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. Maintains contact throughout the life of the file as needed.
* Administers the delivery of timely, appropriate and accurate indemnity and medical benefits.
* Evaluates claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary. Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.
* Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.
* Maintains quality claim files in accordance with appropriate best practices, and other company procedures.
* Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate.
* Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate.
* Serves as a mentor and helps prepare/train the less experienced Claim Department representatives.
* Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.
* Prepares and presents files for Agent/Broker Reviews and Insured File Review.
* Understands medical terminology and standard medical procedures as they pertain to worker’s compensation, U.S. Longshoreman’s and Jones Act claims.
* Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics.
* Maintains a working knowledge of all computer systems currently in use.
* Travels throughout States as required to handle claims inventory assigned.
* Continues education in claims through Associate in Claims or Claims Law (AEI) courses.
Minimum Knowledge, Skills and Abilities
* Four years of workers’ compensation lost time claim handling experience required.
* Bachelor’s degree preferred.
* Computer skills, Word, Excel and Image Right preferred.
* Must have 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 and other resources wisely.
* Must have the ability to work effectively with other organizational team members.
* Full-time required.
Working Conditions
1. Normal office environment with minimal exposure to excessive noise and temperature variations.
2. Willingness to travel among company sites as needed.
3. Will be required to stand and/or sit for extended periods.
4. Will be required to work with a Video Display Terminal.
5. May be required to do occasional reaching and bending.
6. May be required to occasionally exert physical effort (lifting/carrying) using appropriate equipment if needed.
7. Full-time required.
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. Additionally, we are committed to providing an inclusive and accessible recruitment experience for all candidates. If you need a reasonable accommodation during the interview process, please contact us at hr@memic.com.
To ensure an equitable and authentic interview process, candidates should not use AI or chatbot tools during the live interview or phone screen. We welcome any preparation you choose to do beforehand, but all responses shared during the interview must be your own.
Note: MEMIC does not offer Stem-OPT EAD Extension for this role.
MEMIC's Job Applicant Privacy Notice
Check out our benefit offerings here! Targeted salary range: $70-$95,000
Create a Job Alert
Interested in building your career at MEMIC? Get future opportunities sent straight to your email.
Apply for this job
*
indicates a required field