Role 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. Benefits - Health Plans: Medical, Dental, and Vision, including 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.

Role Description Are you a seasoned claims professional with a passion for navigating complex cases? MEM Insurance is seeking a Senior Claims Representative to join our Claims team. In this pivotal role, you’ll manage high-exposure workers’ compensation claims, lead investigations into coverage and fraud, and collaborate across departments to drive strategic outcomes. You’ll be a key decision-maker, a mentor to junior adjusters, and a champion of process improvement—all while ensuring exceptional service and regulatory compliance. Essential Duties and Responsibilities: - Claims Handling & Administration: - Manage highly complex claims involving significant financial exposure, legal intricacies, and extended life cycles. - Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations. - Oversee medical case management for catastrophic injuries and lifetime care needs. - Review and authorize large or complex medical bills, negotiating adjustments to control costs. - Return-to-Work Management: - Develop comprehensive RTW strategies in collaboration with policyholders, legal counsel, and vocational consultants. - Ensure precision in benefit calculations for high-exposure claims, addressing tax and compliance risks. - Strategically deploy investigative efforts aligned with broader claims strategy. - Claims Investigation & Loss Prevention: - Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit. - Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery. - Settlements & Negotiation: - Partner with legal teams to negotiate complex settlements and manage litigation processes. - Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement. - Identify opportunities for structured settlements and lead negotiations. - Reporting: - Produce strategic reports on high-profile claims to guide management decisions. - Maintain system data integrity and prepare claims for Corporate Plan of Action meetings. - Collaboration: - Lead cross-departmental efforts to improve claims handling and risk management. - Resolve escalated customer service issues and support high-value accounts. - Participate in workflow improvement initiatives and committees. - Team Leadership: - Mentor and coach junior and intermediate adjusters. - Review escalated claims and provide actionable feedback. - Support workforce development and succession planning. Qualifications - Bachelor’s degree in business or related field preferred, or equivalent industry experience. - 7–10 years of claims handling experience, with high exposure to Workers’ Compensation. - Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain. - Texas All-Lines license preferred. - Valid driver’s license required. Benefits - Health Plans: Medical, Dental, and Vision, including 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.

Title: Senior Claims Specialist I, Workers Compensation - West Region Location: Rocklin United States, Job Category Claims Subcategory Casualty Claims Typical Starting Salary $77,300 to $102,500 Minimum Salary $67,000.00 Maximum Salary $126,000.00 Schedule Full-Time Flexible Time Off Annual Accrual - days 15 Travel 10% Job Description: Are you looking for an opportunity to join a fast-growing company that consistently outpaces the industry in year-over-year growth? Liberty Mutual offers an exciting opening for a Senior Workers Compensation Claims Specialist within the West Region! The Senior Claims Specialist works within a Claims Team, using the latest technology to review, analyze and process claims that are routinely characterized as moderately complex to complex within assigned authority limits. This includes making decisions about liability/compensability, evaluating losses, negotiating settlements and managing an inventory of commercial property/casualty claims involving bodily injury or property loss. The Senior Claims Specialist may also assist the Claims Team Manager with assigning new claims to team members, providing technical direction, and monitoring caseloads. Depending on your overall skills and experience, you may be considered as a Senior Claims Specialist I, or Senior Claims Specialist II. The salary range posted reflects the varying pay scale across various locations. Candidates must reside within 50 miles of Lake Oswego, OR; and Chandler, AZ; and will be required to work onsite twice a month. Candidates residing in CA and WA will be considered in all locations and may be eligible for 100% remote work. Please note that this policy is subject to change. Responsibilities: - Plans and conducts investigations of claims (including such activities as interviewing insureds, witnesses and claimants, collecting and evaluating appropriate documentation and securing evidence and protecting the chain-of-custody) to analyze and confirm coverage and to determine liability, compensability and damages. - Determines need for, and engages independent adjusters, cause and origin experts and independent medical examiners. - Refers to claim to subrogation group or Special Investigations Unit as appropriate. - Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves, as necessary, during the processing of the claim. - Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. - Coordinates the litigation activities associated with assigned claims to ensure a timely and cost-effective resolution; attends trials as a representative of the company. - Acts as senior technical professional on team, assisting team members with escalated issues. - Mentors and trains new team members. - Participates in Quality Review process. - Participates in conducting Suit Committees, Roundtables, Arbitrations, Mediations, field investigations and may assist in conducting closed file reviews. - Performs other duties as assigned. Qualifications - Excellent interpersonal skills to communicate and negotiate with customers and conduct investigations required. - Leadership ability and demonstrated time management skills to delegate work appropriately and organize resources effectively. - Demonstrates an advanced knowledge of claims case handling practices, legal liability, general insurance policy coverage, and the states tort laws as normally acquired through a bachelors degree (or equivalent training) plus 3 to 5 years directly related work experience. - Required to obtain and maintain all applicable licenses. About Us Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. Fair Chance Notices - California - Los Angeles Incorporated - Los Angeles Unincorporated - Philadelphia - San Francisco

Role Description This position is responsible for the review of Dental appeals by providing an independent review of the facts and circumstances, within the state and federal regulations including ERISA/DOL. In this role, you will act on new dental appeals within 5 business days, and render appeal decisions within 15 days for pre-service, and 30 days for post-service. Written communication of appeal upholds will be clear and concise, and site decision rationale in clear, easy to understand terms. You will partner with other departments, such as Enrollments and DentalConnect as needed, while adhering to PHI. - You will analyze & process claims by investigating information. - Apply claim policies & procedures and engage intervention of internal/external resources to ensure fair, ethical, & timely management of assigned claims. - Analyze and interpret complex coverage contracts to determine if eligibility is met. - Liaise with various stakeholders from across the business (Enrollments, DentalConnect) to obtain needed information to clarify and address issues. - Provide customers with explanations of policy details and claim determination. - Effectively utilize and implement policies & procedures regarding overall claims workflow. - Propose and develop practices & processes to improve performance and the customer experience. - Work as an individual and part of a team to ensure all new appeal assignments are acted on within department turnaround times. Qualifications - High School diploma or GED or minimum Associate degree in lieu of required experience. (Minimum Required) - 3 - 5+ Years of claims processing experience directly aligned to the specific responsibilities for this role. (Required) - 3-5 years experience processing dental claims. (Nice to have) - Understand dental medical terms, records and test results. (Nice to have) - Ability to read, analyze and interpret Dental policies. (Nice to have) - Demonstrate strong written and verbal communication. (Nice to have) - Ability to work with others in a team environment. (Nice to have) - Demonstrates excellent organizational skills with the ability to prioritize workload and multi-task while maintaining strict attention to detail. (Nice to have) - Demonstrates strong interpersonal skills with a collaborative style. (Nice to have) - Demonstrates the ability to use sound judgment and discretion regarding confidential information. (Nice to have) Benefits - Clearly defined career tracks and job levels, along with associated behaviors for each of Lincoln's core values and leadership attributes. - Leadership development and virtual training opportunities. - PTO/parental leave. - Competitive 401K and employee benefits. - Free financial counseling, health coaching and employee assistance program. - Tuition assistance program. - Work arrangements that work for you. - Effective productivity/technology tools and training. Company Description Lincoln Financial (NYSE: LNC) helps people to confidently plan for their version of a successful future. We focus on identifying a clear path to financial security, with products including annuities, life insurance, group protection, and retirement plan services. - With our 120-year track record of expertise and integrity, millions of customers trust our solutions and service to help put their goals in reach. - Lincoln Financial Distributors, a broker-dealer, is the wholesale distribution organization of Lincoln Financial. - Lincoln Financial is the marketing name for Lincoln Financial Corporation and its affiliates including The Lincoln National Life Insurance Company, Fort Wayne, IN, and Lincoln Life & Annuity Company of New York, Syracuse, NY.