The Claim Specialist II-IV investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. (Supervisor will determine actual individual authority up to the stated maximum). Conducts training classes (including research and position papers) for less experienced Claim Department Representatives. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.
Principal Duties and Responsibilities
1. Communicates with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters to obtain and relate necessary information to determine coverage/compensability, facts of loss, and degree of liability/exposure. Maintains contact throughout the life of the file as needed.
2. Administers the delivery of timely, appropriate and accurate indemnity and medical benefits.
3. Evaluates claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary. Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.
4. Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.
5. Maintains quality claim files in accordance with appropriate best practices, and other company procedures.
6. Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor progress as appropriate.
7. Interacts with State and Federal Boards and Commissions, while establishing and maintaining proper reserves, as appropriate.
8. Serves as a mentor and helps prepare/train the less experienced Claim Department representatives.
9. Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.
10. Prepares and presents files for Agent/Broker Reviews and Insured File Review.
11. Understands medical terminology and standard medical procedures as they pertain to worker’s compensation, U.S. Longshoreman’s and Jones Act claims.
12. Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics.
13. Maintains a working knowledge of all computer systems currently in use.
14. Travels throughout States as required to handle claims inventory assigned.
15. Continues education in claims through Associate in Claims or Claims Law (AEI) courses.
Minimum Knowledge, Skills and Abilities
1. A minimum of three years of workers’ compensation lost time claim handling experience required.
2. Bachelor’s degree preferred.
3. Computer skills, Word, Excel and Image Right preferred.
4. Must have a valid driver’s license.
5. Strong attention to detail and strong communication skills both verbal and written.
6. Adaptable/flexible and self-directed with the ability to manage time, multiple priorities and other resources wisely in a fast-paced environment.
7. Must have the ability to work effectively with other organizational team members.
Our comprehensive benefits package includes all traditional offerings such as:
We also offer other benefits to help foster a healthy, balance lifestyle such as:
Salary range is $80-$100,000 depending on experience.
MEMIC is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, age, disability, genetics, gender identity, veteran's status, sexual orientation, or any other characteristic protected by law.
The MEMIC Group, headquartered in Portland, Maine, is a leading super-regional workers' compensation specialty insurer. Often referred to as the "Maine Miracle" by the press, MEMIC was founded in 1993 with the goal of lowering injury rates and workers’ compensation costs for Mainers and their employers. The MEMIC Group is dedicated to improving workers’ comp through compassion, trusted partnerships, and an unwavering commitment to workforce safety. MEMIC’s professionals are located throughout the Northeast, Mid‑Atlantic, and Southeast and are licensed in all states. The MEMIC Group employs over 500 people. Rated “A” (Excellent) by A.M. Best, The MEMIC Group insures and serves more than 20,000 employers and their estimated 300,000 employees with dedicated safety and injury management service teams.
What makes MEMIC different is our commitment to partnership, safety, and compassionate care. Our values of curiosity, partnership, transparency, expertise, and conscientiousness create an environment where employees can be their authentic selves and thrive professionally. These values drive our collaborative culture, fostering strong relationships with colleagues and customers.
MEMIC is proud to be represented by a select group of independent local insurance agencies. Each agency relationship is managed directly by a local Senior Production Underwriter, responsible for all new and renewal business. Loss Control, Claims, and Premium Audit services are all provided by local MEMIC team members.
At MEMIC, we are dedicated to ensuring our employees receive the best benefits in the industry. We offer a comprehensive package that supports work-life balance, including health, dental, life, short-term and long-term disability insurance, a 401(k), and generous paid time off. Our commitment to professional development and excellence is what we call the MEMIC difference.
