Medical Only Claims Representative

Are you passionate about helping others and ensuring quality care in the workers’ compensation space? MEM Insurance is seeking a detail-oriented and service-driven Medical-Only Claims Representative to join our Claims team. In this role, you’ll manage a caseload of medical-only workers’ compensation claims, ensuring compliance with state regulations and MEM guidelines. You’ll collaborate across departments, deliver exceptional service to stakeholders, and help protect the interests of our policyholders and injured workers.

At MEM, we don’t just care about our customers—we care deeply about our employees. We foster a culture of collaboration, integrity, and continuous learning. If you’re looking for a place where your work makes a meaningful impact and your growth is supported, we’d love to meet you.

Essential Duties and Responsibilities Claims Handling and Administration

• Investigate claims for coverage and document findings to support MEM’s position.
• Manage medical-only claims, escalating complex or potentially fraudulent cases appropriately.
• Oversee medical aspects of claims to ensure quality, cost-effective care, including coordination with network providers, Utilization Management, and Nurse Case Management.
• Review and process medical bills promptly and accurately.
• Expand claims handling capabilities to include coverage in states outside Missouri.

Claims Investigation and Loss Prevention

• Identify and investigate subrogation opportunities to maximize recovery.
• Establish and maintain accurate claim reserves, adjusting as needed and documenting rationale.
• Recognize claims with Medicare exposure and coordinate with Corporate Claims to ensure compliance and proper reporting.

Reporting and Documentation

• Maintain thorough documentation of all claim actions, investigative notes, and required reports in compliance with state and federal regulations.
• Ensure data integrity by accurately entering and updating system information.

Collaboration and Customer Service

• Communicate effectively with internal teams including Underwriting, Premium Consultation, and Safety & Risk Services.
• Provide timely updates and support to Producers and Policyholders.
• Respond promptly to inquiries, complaints, and training needs.
• Prioritize tasks to manage caseload efficiently and identify emerging issues for reassignment when necessary.
• Navigate challenging situations with empathy and professionalism, including cultural and language barriers.
• Serve as a resource to colleagues and participate in ongoing legal and regulatory training.

Qualifications

• Experience: Minimum of 1 year in a customer service role with exposure to medical terminology.
• Licenses: Valid driver’s license required.
• Certifications: Associate in Claims (AIC) or other insurance designations preferred but not required.

Company Culture and Values At MEM Insurance, we live our values every day. We believe in doing the right thing, putting people first, and delivering exceptional service. Our culture is built on trust, teamwork, and a shared commitment to excellence. We support our employees with meaningful work, opportunities for growth, and a workplace where everyone belongs.

We are proud to be an equal opportunity employer. MEM Insurance celebrates diversity and is committed to creating an inclusive environment for all employees. We welcome applicants of all backgrounds and experiences.

Total Rewards Overview Health Plans: Medical, Dental, and Vision

• Fertility benefits and fully paid preventative care
• Dental coverage includes adult orthodontia and other uncommon treatments

Fully Employer-Paid Life and Disability Benefits

• Life Insurance – three times base salary
• Accidental Death and Dismemberment
• Short and Long-term Disability

Employee Wellness and Recognition Program

• Employer-paid incentives for employees and their spouses

Flexible Spending and Savings Accounts

• FSA and Dependent Care options
• HSA with generous employer contribution

Time Away from Work

• Generous PTO accruals
• 11 Holidays and 4 Early releases
• 16 Hours of Volunteer Time Off
• 20 days of paid parental leave (in addition to STD)
• Marriage, Bereavement, and Jury Duty leave policies

Additional Benefits

• Employee Assistance Programs
• 401k Retirement Plan with employer match and profit sharing
• Adoption Assistance
• Tuition Assistance

Ready to make a difference? Join MEM Insurance and help us deliver compassionate, compliant, and high-quality claims service. Apply today!