Job Details
The Mission of The MEMIC Group is to make workers' comp work better with compassion, trusted partnerships, and relentless commitment to workforce safety. The secret to the success and longevity of great organizations is their shared vision and strong values. At MEMIC our values are to be conscientious, to be an expert, to be a partner, to be curious and to be transparent.
The Associate Claim Specialist investigates, evaluates, negotiates, and resolves low, medium and high complexity medical only claims and low complexity lost time claims, including new lost time files that are within settlement and reserve authority up to maximum. (Supervisor will determine actual individual authority up to the stated maximum).
Requirements:
- 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.
- Administers the delivery of timely, appropriate medical and indemnity benefits when applicable.
- Evaluates claim exposure, investigates, negotiates, and resolves medical only and lost time claims with potential for modified duty or periods of total disability.
- Maintains quality claim files in accordance with best practices, company policy, procedures and state workers' compensation statutes.
- Implements Managed Care strategies, coordinates rehabilitation or medical management, processes bills, reviews all mail through ImageRight, and monitors progress as appropriate.
- Interacts with State and Federal Boards and Commissions, while establishing and maintain proper reserves, as appropriate.
- Keeps up to date on State laws and Company procedures relating to various claims and educates injured worker and/or insured on same.
- Participates in in-house and outside training programs to keep up to date on relevant issues/topics.
- Understands medical terminology and standard medical procedures as they pertain to workers' compensation.
- Maintains a working knowledge of all computer systems currently in use.
- Travels throughout States as required for handling claims inventory assigned.
- Continues education in claims through WCP, Associate in Claims, or Claims Law (AEI) courses.
Requirements: - No previous experience needed; on-the-job training provided.
- Proficient in Microsoft Office (Word and Excel).
- Must have valid driver's license.
- Strong attention to detail and strong verbal and written communication skills a must.
- Must have flexibility and be self-directed with ability to manage time and other resources wisely.
- Must have the ability to work effectively with other organizational team members.
- If jurisdiction requires, obtain required adjuster licenses within 6 months of employment, or earlier, at manager discretion. Additional licenses may be required throughout course of employment.
Our comprehensive benefits package includes all traditional offerings such as:- Health Insurance options, Dental Insurance options and Vision Insurance
- Employee Life Insurance/AD&D and Dependent Life Insurance options
- Short-term & Long-term Disability
- Health Savings Account with potential employer match
- Flexible Medical and Dependent Care Account
- Accident Insurance
- Critical Illness Insurance
- Employee Assistance Program
- Legal/Identify Theft Insurance options
- Long Term Care Insurance
- Pet Insurance
- 401 (k) Retirement Plan with match up to 5%, plus profit sharing & discretionary contributions (subject to vesting)
- 4 weeks of Paid Time Off (PTO)
- 7 paid holidays
We also offer other benefits to help foster a healthy, balance lifestyle such as:- Flextime schedules
- Paid Parental Leave
- Student loan paydown and refinancing assistance
- Educational assistance for job related courses, seminars, certifications or degrees
- One paid day every year to volunteer for your non-profit of choice
- On-site fitness center (Maine & Virginia) or fitness reimbursement
- Subsidized parking
- Sit-Stand desks & daily stretch breaks
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. MEMIC is an equal opportunity employer encouraging diversity in the workplace.
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