Role Description Are you a detail-oriented professional with a passion for helping others and navigating complex situations? MEM Insurance is seeking a Claims Representative to join our collaborative and mission-driven Claims team. In this role, you’ll manage a caseload of moderately complex workers’ compensation claims, ensuring quality care for injured workers while protecting the financial integrity of our policyholders. You’ll work closely with internal teams, policyholders, and external partners to investigate claims, develop return-to-work strategies, and negotiate fair settlements. If you thrive in a fast-paced environment and are committed to making a meaningful impact, we’d love to hear from you. - Investigate and manage moderately complex workers’ compensation claims, ensuring compliance with state laws and MEM guidelines. - Analyze statements and records to determine compensability and communicate findings to stakeholders. - Collaborate with Nurse Case Managers and external vendors to oversee medical case management, including lifetime care planning and permanent restrictions. - Develop tailored Return-to-Work (RTW) strategies in partnership with policyholders, ensuring accommodations align with medical restrictions. - Calculate and issue accurate disability benefits in accordance with statutory requirements. - Identify and investigate potential fraud or abuse in coordination with the Special Investigation Unit. - Establish and maintain appropriate claim reserves, adjusting as needed based on evolving claim circumstances. - Negotiate settlements within authority levels and collaborate with legal counsel on litigated claims. - Ensure Medicare compliance, including coordination of Medicare Set-Aside Trusts when applicable. - Maintain thorough documentation and data accuracy in all claim files and systems. - Provide timely updates on high-exposure or high-profile claims to management. - Collaborate cross-functionally with Underwriting, Premium Consultation, and Loss Prevention teams. - Deliver exceptional service to internal and external customers, including policyholders and producers. - Participate in workflow improvement initiatives and support onboarding of new team members. - Stay current with workers’ compensation laws and best practices through ongoing training and development. Qualifications - 2–4 years of claims handling experience, with a strong preference for workers’ compensation experience. - Associate in Claims (AIC) designation preferred. - Texas All-Lines Adjuster License 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 Investigates, evaluates, reserves and resolves Commercial Automobile, First Party Property and General Liability claims for self-insured and unbundled clients. Provides a superior level of customer service to internal and external business partners. Administers and resolves claims for TPA clients in a timely manner and in accordance with client, company and regulatory guidelines. - Promptly investigates all assigned claims for coverage, liability, damages, subrogation and contribution. - Ensures timely disposition of all claims in accordance with client, regulatory and statutory requirements. - Within granted authority, establishes appropriate loss and expense reserves with documented rationale. - Maintains and adjusts reserves over the life of the claim to reflect changes in exposure. - Notifies appropriate claims management and clients when exposure exceeds authority. - Negotiates claims resolution within granted authority. - Establishes and executes appropriate action plans for claim resolution including loss cost management while achieving appropriate balance between allocated expense and loss outcome. - Works collaboratively with the client and internal and external business partners in investigating and reaching appropriate disposition of all claims. - Selects and manages service vendors to achieve appropriate balance between allocated expense and loss outcome. - Maintains a working knowledge of regulatory and jurisdictional requirements for assigned claims territory. - Demonstrates technical proficiency through timely, consistent execution of best claim practices and established claims handling guidelines. - Communicates effectively with internal and external customers on claims and account issues. - Provides a high degree of customer service. - Maintain and manage a diary system and claim pending to efficiently and effectively resolve all claims. - Potential local travel. - Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work. Qualifications - Bachelor's degree and a minimum of 3 years of progressively responsible experience handling Commercial Automobile, First Party Property and General Liability claims required. - Experience handling NJ claims. - Familiarity with coverage, negligence principles, investigation and negotiation techniques. - Obtains and maintains state adjusting licenses, as needed. - Ensures that all state-required Continuing Education Credits are obtained as needed to maintain license. - Strong organizational skills and detail oriented. - Ability to work independently, handle multiple tasks simultaneously and exercise good judgment. - Working knowledge of Auto, Liability and Property claims handling practices. - Excellent verbal and written communication skills. - Excellent customer service skills. - Computer literacy, including working knowledge of MS Office including Word, Excel and PowerPoint.

Role Description As a member of our claims team, utilize your knowledge of Workers Compensation to independently investigate, evaluate and resolve assigned claims of a more complex nature in order to achieve appropriate outcomes. In this position you will administer and resolve highest risk management expectations claims in a timely manner in accordance with legal statutes, policy provisions, and company guidelines. - Promptly investigate all assigned claims with minimal supervision, including those of a more complex nature - Determine coverage, compensability, potential for subrogation recovery, and second injury fund (when applicable) - Alert Supervisor and Special Investigations Unit to potentially suspect claims - Ensure timely denial or payment of benefits in accordance with jurisdictional requirements - Establish appropriate reserves with documented rationale, maintain and adjust reserves over the life of the claim to reflect changes in exposure - Negotiate claims settlements with client approval - Establish and implement appropriate action plans for case resolution including medical and disability management, litigation management, negotiation and disposition - Work collaboratively with PMA nurse professionals to develop and execute return to work strategies - Select and manage service vendors to achieve appropriate balance between allocated expense and loss outcome - Maintain a working knowledge of jurisdictional requirements and applicable case law for each state serviced - Demonstrate technical proficiency through timely, consistent execution of best claim practices - Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account issues - Provide a high degree of customer service to clients, including face to face interactions during claims reviews, stewardship meetings and similar account-specific sessions - Authorize treatment based on the practiced protocols established by statute or the PMA Managed Care department - Assist PMA clients by suggesting panel provider information in accordance with applicable state statutes - Demonstrate commitment to Company’s Code of Business Conduct and Ethics, and apply knowledge of compliance policies and procedures, standards and laws applicable to job responsibilities in the performance of work Qualifications - CA License and SIP designation required; Must reside in CA - Bachelor's degree, or four or more years of equivalent work experience required in an insurance related industry required - At least 3-5 years' experience handling lost time workers compensation claims required; past experience with CA jurisdiction is required - Associate in Claims (AIC) Designation or similar professional designation desired - Active license required or ability to obtain license within 90 days of employment in mandated states - Familiarity with medical terminology and/or Workers' Compensation - Strong organizational skills with demonstrated ability to work independently and deal effectively with multiple tasks simultaneously - Proven critical thinking skills that demonstrate analysis/judgment and sound decision making with focus on attention to details - Strong verbal, written communication skills and customer service skills - Computer literacy, including working knowledge of MS Office Product Suite, i.e. Word, Excel, PowerPoint - Ability to travel for business purposes, approximately less than 10% Requirements PMA is providing applicants with the anticipated wage range for this position in compliance with state regulations. The wage range for this role is $75,000 to $101,000. Wage ranges are based on national market data and may cover a wide range of geographies. Applicants may be paid above, within or below this range based on a variety of factors.

Role Description This position has the ability to work remotely. Under moderate supervision and following standard procedures with some independent judgment, collaborates with all claims functions to support the achievement of claims division goals through the development and implementation of policies, guidelines, processes and procedures representing claims best practices throughout the claims division. Conducts quality reviews. Develops and/or delivers programs to develop staff knowledge, skills and abilities. Essential Duties and Responsibilities: - Researches, develops, recommends and implements claims policies, guidelines, processes and procedures. - Monitors the performance of claims in all lines of business and makes recommendations for improvement. - Acts as a subject matter expert, providing technical expertise to claims staff in claims handling and claims operations. - Researches, develops, analyzes and improves claims reports to assist claims leadership and staff in the management of claims operations. - Develops and executes effective internal quality control processes and procedures to ensure a consistent work product, including the design and coordination of claims internal audit processes and large loss oversight. - Ensures compliance with regulatory and legal requirements, including reinsurance. - Oversees claims vendor management programs. - Serves as Business Lead and/or resource on corporate projects representing the claims staff. - Performs other duties as assigned. Qualifications - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. - The requirements listed below are representative of the knowledge, skill, and/or ability required. - Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - Level 5: Bachelor’s degree (B.A.) from four-year college or university; or four to six years related experience and/or training; or equivalent combination of education and experience. - A minimum requirement for this position is the ability to work legally in the United States. No visa sponsorship/support is available for this position, including for any type of U.S. permanent residency (green card) process. Company Description