Associate Claim Specialist

1 week ago

Portland, Maine, United States Opportunities at MEMIC Full time
Job Title: Associate Claim Specialist

At MEMIC, we're committed to making workers' comp work better with compassion, trusted partnerships, and a relentless commitment to workforce safety. As an Associate Claim Specialist, you'll play a critical role in achieving this mission.

Job Summary

We're seeking a highly motivated and detail-oriented individual to join our team as an Associate Claim Specialist. In this role, you'll investigate, evaluate, negotiate, and resolve low, medium, and high complexity medical only claims and low complexity lost time claims. Your strong communication skills and ability to work effectively with insureds, injured workers, agents, brokers, witnesses, attorneys, loss prevention, and underwriters will be essential in determining coverage, compensability, and liability exposure.

Key Responsibilities
  • Communicate with stakeholders to obtain and relate necessary information to determine coverage and liability exposure.
  • Administer timely and appropriate medical and indemnity benefits when applicable.
  • Evaluate claim exposure, investigate, negotiate, and resolve medical only and lost time claims.
  • Maintain quality claim files in accordance with best practices, company policy, procedures, and state workers' compensation statutes.
  • Implement Managed Care strategies, coordinate rehabilitation or medical management, process bills, and monitor progress as appropriate.
  • Interact with State and Federal Boards and Commissions, while establishing and maintaining proper reserves as needed.
  • Stay up-to-date on State laws and Company procedures relating to various claims and educate injured workers and/or insureds on the same.
  • Participate in in-house and outside training programs to stay current on relevant issues and topics.
  • Understand medical terminology and standard medical procedures as they pertain to workers' compensation.
  • Maintain a working knowledge of all computer systems currently in use.
  • Travel 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 a valid driver's license.
  • Strong attention to detail and strong verbal and written communication skills are a must.
  • Must have flexibility and be self-directed with the 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 the course of employment.
Benefits

We offer a comprehensive benefits package that includes:

  • 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/Identity 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).
  • 10 paid holidays.

We also offer other benefits to help foster a healthy, balanced lifestyle, including:

  • 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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