Medical Only Claims Representative (Remote)

Medical-Only Claims Representative

Are you motivated by helping people through moments that matter while delivering excellent service behind the scenes? MEM Insurance is seeking a Medical-Only Claims Representative to join our Claims team. In this role, you will manage a caseload of workers' compensation medical-only claims, ensuring timely, compliant, and thoughtful handling from first notice through closure. You will play a critical role in coordinating quality medical care, maintaining accurate claim documentation, and collaborating with internal partners to deliver positive outcomes for injured workers, policyholders, and our organization. At MEM, we believe strong claims handling is built on teamwork, accountability, and continuous learning. This position offers the opportunity to grow your claims expertise while being supported by a collaborative culture that values both our customers and our employees.

Essential Duties and Responsibilities

Under the general direction of the assigned Claims Manager, the Medical-Only Claims Representative will:

• Manage a caseload of medical-only workers' compensation claims, ensuring compliance with applicable state regulations and MEM guidelines.
• Investigate assigned claims for coverage, document coverage analyses, and promptly notify the appropriate teams of any potential issues requiring further review.
• Oversee the medical aspects of each claim to support quality, appropriate, and cost-effective care, including coordination with network providers, Utilization Management, and Nurse Case Management when appropriate.
• Review and process medical bills accurately and timely while maintaining complete and well-documented claim files.
• Identify claims that involve increased complexity, potential compensability issues, subrogation, fraud, or Medicare exposure, and escalate or refer those claims to the appropriate internal partners.
• Establish, maintain, and adjust claim reserves in a timely and well-documented manner that reflects current claim exposure and corporate standards.
• Identify and investigate potential third-party liability and document subrogation opportunities to support recovery efforts.
• Maintain accurate system data and file documentation to support regulatory compliance, reporting requirements, and data integrity.
• Collaborate closely with internal teams across MEM, including Underwriting, Premium Consultation, Safety & Risk Services, and Corporate Claims, to support effective claim outcomes.
• Communicate claim status clearly and professionally to policyholders, producers, and internal stakeholders, responding promptly to questions, concerns, or service needs.
• Manage workload effectively to meet productivity and service standards, prioritizing tasks to move claims toward timely resolution.
• Participate in ongoing training, legal updates, and state-specific education to remain current on workers' compensation laws and industry best practices.
• Serve as a resource and support to teammates, contributing to a positive, collaborative team environment.

Qualifications

Education:

• High School diploma or equivalent required
• Bachelor's degree preferred

Designations / Certifications:

• Associate in Claims (AIC) or other insurance designation preferred

Licenses:

• Valid driver's license required

Experience:

• One (1) or more years of experience in a customer service environment, with some exposure to medical terminology

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.
• Annual Performance Based Bonus
• 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.