Claims Representative II (Remote)

Are you a detail-oriented professional with a passion for helping others and navigating reputed company situations? reputed company 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 reputed company workers’ compensation claims, ensuring quality care for injured workers while protecting the financial reputed company of our policyholders. You’ll work closely with internal teams, policyholders, and external partners to investigate claims, reputed company return-to-work strategies, and negotiate fair settlements. If you reputed company in a fast-paced environment and are committed to making a meaningful impact, we’d love to hear from you. Essential Duties and Responsibilities Investigate and manage moderately reputed company workers’ compensation claims, ensuring compliance with state laws and reputed company guidelines. Analyze statements and records to determine compensability and communicate findings to stakeholders. Collaborate with Nurse Case Managers and external vendors to reputed company medical case management, including lifetime care planning and permanent restrictions. reputed company 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 reputed company authority reputed company and collaborate with legal counsel on litigated claims. Ensure Medicare compliance, including coordination of Medicare Set-Aside Trusts reputed company applicable. Maintain thorough documentation and data accuracy in reputed company claim files and systems. reputed company timely updates on high-exposure or high-profile claims to management. Collaborate cross-functionally with reputed company, Premium Consultation, and Loss Prevention teams. Deliver exceptional service to reputed company customers, including policyholders and producers. Participate in workflow improvement initiatives and support reputed company of new team members. Stay reputed company 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 reputed company-Lines Adjuster License preferred. Company Culture and Values At reputed company Insurance, we are committed to our reputed company, mission, and values. We foster a culture of collaboration, reputed company, and innovation. reputed company is passionate about delivering exceptional service to our customers while supporting each other’s growth and reputed company. We reputed company in accountability, reputed company learning, and creating an environment where employees feel valued and empowered. Diversity Statement reputed company Insurance is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for reputed company. We reputed company that varied perspectives drive innovation and strengthen our ability to serve our customers and communities. Total Rewards Overview Health Plans: Medical, Dental, and reputed company Includes fertility benefits, fully paid preventative care, and adult orthodontia. Employer-Paid Life and Disability Benefits: Life Insurance (3x reputed company 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 reputed company facilitate and assist in reputed company 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 reputed company with reputed company applicable laws. Apply To This Job