Role Description This position is responsible for entering paper and/or electronic claims into the claims system and examining and determining whether to return, request additional information, deny or pay claims following organizational policies and procedures after entry. After the appropriate training, incumbents are expected to meet the minimum levels for quality and production as measured by the Claims Department. Essential Responsibilities - Accurately examine, interpret and enter claims; resolve edits and first/second level suspense utilizing the claims processing system. - Perform necessary research and effectively make decisions to properly adjudicate claims utilizing processing manual. - Identify and communicate problems relevant to the claims processing system and the processing manual and/or guidelines. - Adhere to all established standard operating procedures. - Support continuous improvement by identifying process improvements and/or quality enhancements. - Initiate and respond to written and verbal communications from internal and external sources. - Perform Claim Adjustments of initial claims for internal and external adjustment reasons, resolving claims suspensions resulting from claim adjustments. - Resolve Medicare Secondary Payor (MSP) edits/audits/reason codes. - Perform other duties as the supervisor may, from time to time, deem necessary. Qualifications - High School Diploma or GED - 1 year of data entry experience, including accurate keyboard skills - Proficient with PCs and in Windows based environments; including Microsoft Office (Word, Excel, Outlook) - Demonstrated analytical skills - Strong verbal and written communication skills - Strong interpersonal skills Preferred Qualifications - Knowledgeable of medical terminology, procedure and denial codes Requirements - The Federal Government and the Centers for Medicare & Medicaid Services (CMS) may require applicants to have lived in the United States for a minimum of three (3) years out of the last five (5) years to be employed with the Company. These years of residence do not have to be consecutive. - Background Investigation: If you are selected for this position, you must undergo a pre-employment Background Investigation, Drug Screen, and Identity Proofing documentation must be cleared prior to hire. Most positions are subject to additional Identity Proofing, Fingerprinting and additional Background Investigation screening conducted by the Federal Government to be granted Enterprise User Administration (EUA) system logical access after you begin your employment. Your continued employment is contingent upon the outcome of the complete additional screening criteria required for the position which must find that you meet the applicable government customer's requirements (e.g., suitable for access to CMS information and information systems), as well as any additional investigation which may be required throughout your employment. If you are found not suitable, your employment may be subject to corrective action, up to and including immediate termination of employment. - Identity Documentation: You must have access to a current and unrestricted REAL ID, U.S. Passport, U.S. Passport Card, Foreign Passport, or U.S. Permanent Residency Documents. Note: Employment Authorization Cards (EAD) are not a substitute for Visas or U.S. Permanent Resident Cards. Benefits - Medical, dental, vision, life and supplemental insurance plans effective the first day of the month following date of hire - Short- and long-term disability benefits - 401(k) plan with company match and immediate vesting - Free telehealth benefits - Free gym memberships - Employee Incentive Plan - Employee Assistance Program - Rewards and Recognition Programs - Paid Time Off and Paid Sick Leave Company Description Are you interested in joining a team of experienced healthcare experts and have the ability to shape and transform the healthcare delivery system? At our family of companies, everything we do is to help improve the lives of the nearly 12 million Medicare beneficiaries we serve and 700,000 health care providers who care for them. It is our goal to help create a better health experience for all consumers. Join our winning culture and help transform Medicare for the millions of people who rely on its services.

Title: Senior Workers' Compensation Claim Representative Location: CA - Diamond Bar CA - Irvine Full time Hybrid Job Description: Who Are We? Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Job Category Claim Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards. Salary Range $70,400.00 - $116,200.00 What Is the Opportunity? This role is eligible for a sign-on bonus. This position is eligible for a hybrid schedule. Employees may work up to 2 days per week at their primary residence. This position will office out of the Diamond Bar or Irvine locations. Under general supervision, manage Workers' Compensation claims with lost time to conclusion and negotiate settlements where appropriate to resolve claims. Coordinate medical and indemnity position of the claim with a Medical Case Manager. Independently handles assigned claims of low to moderate complexity where Wage loss and the expectation is a return to work to modified or full duty or obtain MMI with no RTW. There are no litigated issues or minor to moderate litigated issues. The claim may involve minor sprains/ minor to moderate surgery. The Injured worker is working modified duty and receiving ongoing medical treatment. The injured worker has returned to work, reached Maximum Medical Improvement (MMI) and is receiving PPD benefits. File will close as soon as the PPD is paid out. Independently handles all assigned claims up to and including most complex where Injured worker (IW) remains out of work and unlikely to return to position. Employer is unable to accommodate the restrictions. The claim involves moderate to complex litigation issues IW has returned to work, reached Maximum Medical Improvement (MMI), and has PPD. File litigated to dispute the permanency rating and/or causality. IW has been released to work with permanent restrictions and job is no longer available. IW is receiving Vocational Rehabilitation. Claims that have been reopened for additional medical treatment on more complex files. Injuries may involve one or multiple back, shoulder or knee surgeries, knee replacements, claims involving moderate to complex offsets, permanent restrictions and/or fatalities. Claims on which a settlement should be considered. What Will You Do? - Conduct investigations, including, but not limited to assessing policy coverage, contacting insureds, injured workers, medical providers, and other parties in a timely manner to determine compensability. - Establish and update reserves to reflect claim exposure and document rationale. Identify and set actuarial reserves. Apply knowledge to determine causal relatedness of medical conditions. - Manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with internal nurse resources where appropriate. - Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome. Work in collaboration with specialty resources (i.e. medical and legal) to proactively pursue claim resolution opportunities, (i.e. return to work, structured settlement, and discontinuation of benefits through litigation). - Develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcome - Collaborate with our internal nurse resources (Medical Case Manager) in order to integrate the delivery of medical services into the overall claim strategy. - Prepare necessary letters and state filings within statutory limits. Pursue all offset opportunities, including apportionment, contribution and subrogation. - Evaluate claims for potential fraud. Proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment. - Proactively manage moderate to complex litigation to drive files to an optimal outcome, including resolution of benefits. Understand and apply Medicare Set Asides and allocations. - Negotiate settlement of claims within designated authority. May use structured settlement/annuity as appropriate for the jurisdiction. Apply deep technical expertise to assist in the resolution of highly complex claims. Mentor other Claim Professionals - Participate in Telephonic and/or onsite File Reviews. Respond to inquiries – verbal and written. Keep injured worker apprised of claim status - Act as technical resource to others. - Participate in Telephonic and/or onsite File Reviews. Respond to inquiries – verbal and written. Keep injured worker apprised of claim status. Act as technical resource to others. Engage specialty resources as needed. - Performs other assigned duties which may include: Applies deep technical/subject matter expertise to assist in the resolution of complex claims. Acts as an independent mentor to other Claim Professionals. May be dedicated to and apply skills necessary to manage special account relationships (sensitive or complex). May primarily manage a specialized inventory of Workers’ Compensation claims. - Acts as an independent mentor to other Claim Professionals Applies deep technical/subject matter expertise to assist in the resolution of complex claims - Acts as an independent mentor to other Claim Professionals - In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) may be required to comply with state and Travelers requirements. Generally, license(s) must be obtained within three months of starting the job and obtain ongoing continuing education credits as mandated. - Maintain Continuing Education requirements as required. - Perform other duties as assigned. What Will Our Ideal Candidate Have? - Education/Course of Study: Work Experience: - Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making. - Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. - Ability to effectively present file resolution to internal and/or external stakeholders. - Negotiation: Advanced evaluation, negotiation and case resolution skills. - Ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise. - General Insurance Contract Knowledge: Interprets policies and contracts, applies loss facts to policy conditions, and determines whether or not a loss comes within the scope of the insurance contract. - Principles of Investigation: Intermediate investigative skills including the ability to take statements. - Follows a logical sequence of inquiry with a goal of arriving at an accurate reconstruction of events related to the loss. - Value Determination: Advanced ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves. - Settlement Techniques: Advanced ability to assess how a claim will be settled, when and when not to make an offer, and what should be included in the settlement offer package. - Legal Knowledge: Thorough knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. - Medical knowledge: Intermediate knowledge of the nature and extent of injuries, periods of disability, and treatment needed. - WC Technical: - Advanced ability to demonstrate understanding of WC Products and ability to apply available resources and technology to resolve claims. - Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state. - Advanced knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. - Customer Service: - Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes. - Teamwork: - Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result. - Planning & Organizing: - Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals. What is a Must Have? - High school diploma or equivalent. - 2 years Workers Compensation claim handling experience. What Is in It for You? - Health Insurance: Employees and their eligible family members – including spouses, domestic partners, and children – are eligible for coverage from the first day of employment. - Retirement: Travelers matches your 401(k) contributions dollar-for-dollar up to your first 5% of eligible pay, subject to an annual maximum. If you have student loan debt, you can enroll in the Paying it Forward Savings Program. When you make a payment toward your student loan, Travelers will make an annual contribution into your 401(k) account. You are also eligible for a Pension Plan that is 100% funded by Travelers. - Paid Time Off: Start your career at Travelers with a minimum of 20 days Paid Time Off annually, plus nine paid company Holidays. - Wellness Program: The Travelers wellness program is comprised of tools, discounts and resources that empower you to achieve your wellness goals and caregiving needs. In addition, our mental health program provides access to free professional counseling services, health coaching and other resources to support your daily life needs. - Volunteer Encouragement: We have a deep commitment to the communities we serve and encourage our employees to get involved. Travelers has a Matching Gift and Volunteer Rewards program that enables you to give back to the charity of your choice.

Title: Workers' Compensation Claims Representative (Remote) Locations: Remote -USA Bloomington, IL, USA Kansas, USA St. Louis, MO, USA Omaha, NE, USA Nebraska, USA Iowa, USA Illinois, USA Missouri, USA Columbia, MO, USA Kansas City, MO, USA Springfield, MO, USA Tennessee, USA Arkansas, USA Job Description: Are you an experienced claims professional ready to take on complex cases and make a meaningful impact? MEM Insurance is seeking a seasoned Claims Representative to join our dynamic Claims team. In this role, you will manage a caseload of high-exposure workers’ compensation claims, oversee advanced medical case management, and develop tailored Return-to-Work plans. You’ll collaborate with vocational consultants, legal counsel, and internal teams to ensure compliance, negotiate settlements, and deliver exceptional service to our policyholders. This position offers the opportunity to work independently while providing leadership on complex claims and contributing to workflow improvements. Essential Duties and Responsibilities Manage complex workers’ compensation claims involving high financial exposure, sensitive issues, or extended life cycles. Investigate coverage and compensability, ensuring thorough documentation and compliance with state statutes. Oversee advanced medical case management, including coordination with Nurse Case Managers and external vendors. Develop and implement Return-to-Work plans for high-risk claims, collaborating with vocational consultants and legal counsel. Identify and investigate potential fraud and subrogation opportunities, partnering with the Special Investigation Unit. Establish and maintain accurate claim reserves within authority levels, ensuring timely responsiveness to changing circumstances. Evaluate and negotiate settlements within approved authority levels, including structured settlements and Medicare compliance. Collaborate with legal counsel to manage litigation and ensure adherence to MEM guidelines. Maintain accurate system data and prepare reports for management on high-profile claims. Foster cross-departmental collaboration with Underwriting, Premium Consultation, and Loss Prevention. Provide mentorship and training to junior adjusters, supporting professional growth and team development. Qualifications High school diploma or equivalent required; bachelor’s degree preferred. Associate in Claims (AIC) designation preferred. Valid driver’s license required; Texas-All Lines license preferred. 3–5 years of claims handling experience, primarily in Workers’ Compensation. Missouri experience preferred. 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 VisionIncludes fertility benefits, fully paid preventative care, and adult orthodontia. 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 IntelligenceMEM 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. Job Details Pay Type Salary Hiring Min Rate 52,000 USD Hiring Max Rate 78,000 USD

Role Description We are seeking a dedicated Casualty Claims Handler to join our team. In this role, you will be responsible for investigating Employers' Liability and Public Liability insurance claims to determine the extent of liability on behalf of our clients. This involves assessing damages to people and property, communicating with third parties, and determining the appropriate settlement amounts. If you have a keen eye for detail, excellent communication skills, and a passion for delivering exceptional service, we encourage you to apply. How you'll make an impact: - Review claims on our in-house system, ensuring compliance with product standards, verifying policy coverage, and allocating appropriate codes and reserves. - Conduct liability enquiries using the most suitable methods, including phone calls, correspondence, or field visits, in line with the Adjuster’s Manual. - Evaluate claim quantum by gathering relevant evidence and adjusting reserves in accordance with Gallagher Bassett’s realistic reserving philosophy. - Clearly explain liability decisions and negotiate settlements within your authority level, where applicable. - Respond promptly and courteously to all written and phone enquiries. - Regularly review claims using the diary system to ensure accurate reserves and timely claim closures. - Build and maintain strong relationships with clients by providing friendly and efficient service. - Liaise with and manage solicitors to ensure cases are handled effectively and not abandoned. Qualifications - Previous personal injury, employers, and public liability claims handling experience. - Proven ability to verify and analyse coverage for adjuster-level claims with moderate supervision. - Strong investigative skills to establish facts, build rapport with involved parties, and support claims strategies. - Experience in determining liability/compensability for adjuster-level claims. - Familiarity with the litigation process and ability to ensure quality and timely carrier reporting. - Excellent communication and negotiation skills, with a customer-focused approach. - Eligible to work in the UK. Requirements - Please be advised that, due to the nature of this role and the type of clients we serve, an enhanced external background check is a requisite part of our recruitment process. Further information regarding this procedure will be provided during the recruitment process. Benefits - Minimum of 25 days holiday, plus bank holidays, and the option to ‘buy’ extra days. - Defined contribution pension scheme, which Gallagher will also contribute to. - Life insurance, which will pay 4x your basic annual salary, which you can top-up to 10x. - Income protection, we’ll cover up to 50% of your annual income, with options to top up. - Health cash plan or Private medical insurance. - Three fully paid volunteering days per year. - Employee Stock Purchase plan, offering company shares at a discount. - Share incentive plan, HMRC approved, tax effective, stock purchase plan. - Critical illness cover. - Discounted gym membership, with over 3,000 gyms nationally. - Season ticket loan. - Access to a discounted voucher portal to save money on your weekly shop or next big purchase. - Emergency back-up family care. - And many more…