Title: Claim Specialist - Commercial Liability Location: Houston United States Job Description: At FCCI, our people make the difference. Our teammates are committed to upholding FCCI's long-standing traditions of building relationships, serving others and giving back to the community. Come join us and make a difference! Currently seeking an experienced commercial Claim Specialist to provide quality, cost efficient, and timely investigation of liability claims. Responsibilities include maintaining an inventory of claims handled within departmental guidelines, following best practices policies and procedures and budgetary guidelines, field investigations, negotiating limited settlements, setting reserves, attending mediations, and documenting all file activity. Litigation experience is required. This position can be a remote position if located in Texas outside of the DFW Metroplex and will support the Southwest Region claims, supporting the state of Texas and other surrounding states. In exchange for your talents, FCCI offers competitive salaries and an excellent benefits package which includes: - Flexible Work Environment - Paid Family Leave - Competitive PTO & Holidays - Recognition & Bonus Programs - Medical, Vision, Dental & Life Insurance - Employee Referral Bonus - Paid Volunteer Time - 401(k) Match & Profit-Sharing The salary range for this position is $91,389-$140,737 annually. This salary range is an estimate and the actual salary will vary based on applicant's education, experience, knowledge, skills, and abilities. We are an Equal Employment Opportunity employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. Please apply via our website at www.fcci-group.com. Drug Free Workplace (*Pre-employment drug screen is conducted for all positions)

Role Description 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 - 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 - High School diploma or equivalent required - Bachelor’s degree preferred - Associate in Claims (AIC) or other insurance designation preferred - Valid driver’s license required - One (1) or more years of experience in a customer service environment, with some exposure to medical terminology Benefits - Health Plans: Medical, Dental, and Vision, including 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. - 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

Role Description To evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under a personal injury protection and/or medical payment benefits. - Reviews claims to determine the nature of the medical loss and provides explanation of coverage. - Researches policy contract and interprets policy language to make coverage decisions based on 1st party medical coverage. - Assesses medical treatment, evaluates medical bills, and initiates or reviews potential fraud investigations. - Interprets medical records regarding injuries and addresses ongoing and continuous treatment for claimant. - Identifies claim exposures and establishes reserves or adjusts reserves accordingly on assigned files. - Ensures claim files are properly documented and correctly coded based on the policy. - Documents all claim activity and workflow accurately throughout the life of the claim in accordance with standard operating procedures. - Provides effective and timely communication to client, claimants, medical providers, attorney offices, and vendors. - Negotiates resolution of claims and makes payments within authority. - Performs other duties as assigned. Qualifications - Bachelor's degree from an accredited college or university preferred. - State adjuster licenses required. - Three (3) years of Personal Injury Protection (PIP), medical payment and/or workers compensation or equivalent combination of education and experience; nursing experience a plus. - Knowledge of medical terminology and appropriate application of deductibles and limits. - Familiarity with Bodily Injury (BI)/Casualty adjusting. - Oral and written communication skills. - PC literate, including Microsoft Office products. - Organizational skills required. Requirements - Physical: Computer keyboarding. - Auditory/visual: Hearing, vision and talking. - Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines. Benefits - Medical, dental, vision. - 401k and matching. - PTO. - Disability and life insurance. - Employee assistance. - Flexible spending or health savings account. - Other additional voluntary benefits.

Role Description The Claims Specialist resolves medical claims that are not automatically adjudicated by the claims processing system in a timely and accurate manner according to divisional standards of quality and productivity. Resolution may include additional investigation or communication in order to obtain necessary information to complete the claim. Outside issues such as peak filing season, systems down time, inclement weather, holidays, and absenteeism may directly affect the volume of work for each Specialist. Qualifications - High School diploma or equivalent. - Minimum two (2) years' college coursework (48 semester hours) or other equivalent certification with an emphasis in anatomy, medical terminology, math, biology, or a related field. - OR minimum one (1) year of related office experience such as claims processing, health insurance, or medical office. - Must pass company proficiency test: Claims Assessment. Requirements - Oral & Written Communications - Strong Interpersonal skills - Sound Judgement - Decision Making - Detail-Oriented - Teamwork - Dependability - Clinical Judgment - Computer Work - Critical Thinking - Customer Service - Evaluating Information - Interpersonal Communication - Oral Communications - Organizing - Process Information - Reading Comprehension - Researching - Time Management Responsibilities - Claims Processing: Involves the actions required to pay or deny pended claims (those which did not auto-adjudicate), including: - Entering data into the system - Reviewing and interpreting contract benefits - Conducting edit and audit resolution - Determining benefit eligibility - Identifying and researching processing issues through systems and manuals - Routing claims to other areas - Consulting internal staff and medical providers - Generating correspondence - Completing forms to obtain necessary information - Knowledge/Continuous Learning: Must undergo initial training, on-the-job training, and continuing education. Responsibilities include: - Demonstrating knowledge of and possessing the ability to access all relevant computer systems and screens to process claims accurately - Staying current with continually changing processing procedures, benefits, and system modifications - Meeting corporate and national (MTM) standards while maintaining acceptable performance levels based on established departmental standards for productivity and quality - Familiarity with corporate and professional manuals and guidebooks, including the company processing manual and ICD, CPT, and HCPS codebooks - Other duties: As assigned Certifications This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual. Segregation of Duties Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual. Employment Type Regular ADA Requirements 1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.