Job Description
We’re looking for a seasoned Claim Specialist IV to take ownership of complex lost time claims while serving as a mentor and subject matter expert within our Claims team. This is a high-visibility role designed for a skilled professional who thrives in a fast-paced environment, exercises sound judgment, and enjoys elevating the capabilities of others. The Claim Specialist IV investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.
This position can be remote, hybrid or in-person
What You’ll Do
- Own the full claim lifecycle: Investigate, evaluate, negotiate, and resolve lost time workers’ compensation claims within designated settlement and reserving authority
- Analyze complex exposures: Assess compensability, medical, legal, and indemnity factors while proactively managing risk and claim cost drivers
- Navigate jurisdictional requirements: Ensure compliance with state-specific WC laws, litigation processes, and regulatory guidelines
- Strategically manage claims: Develop and execute resolution strategies, including collaboration with defense counsel, medical providers, and vendors
- Exercise advanced judgment: Handle a high-exposure, complex caseload with a high degree of autonomy and limited supervision
- Develop others: Design and deliver training sessions, research materials, and technical guidance for less experienced adjusters
- Serve as a subject matter expert: Provide leadership in best practices, reserving, settlement strategy, and claim handling excellence
What Sets This Role Apart
- Complex, high-impact caseload: Manage litigated and non-litigated lost time claims requiring deep technical expertise
- Expanded authority: Settlement and reserving authority aligned with your experience and demonstrated capabilities
- Influential role: Shape claim outcomes and elevate team performance through mentorship and knowledge sharing
- Cross-functional exposure: Regular collaboration with legal, medical management, underwriting, and risk partners
What You Bring
- Proven experience managing lost time claims with increasing complexity - 4 years of WC lost time claim handling required
- Strong negotiation and analytical skills with a focus on resolution
- Ability to work independently while maintaining high-quality outcomes
- Passion for mentoring, training, and knowledge sharing
- Demonstrated ability to handle confidential, high-impact situations with professionalism
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. Additionally, we are committed to providing an inclusive and accessible recruitment experience for all candidates. If you need a reasonable accommodation during the interview process, please contact us at [email protected]
To ensure an equitable and authentic interview process, candidates should not use AI or chatbot tools during the live interview or phone screen. We welcome any preparation you choose to do beforehand, but all responses shared during the interview must be your own.
Note: MEMIC does not offer Stem-OPT EAD Extension for this role.
Check out our benefit offerings here! Targeted salary range: ___________
