Associate Claims Representative (Remote)

MEM - Missouri Employers Mutual - Columbia, MO

Full-time - Entry Level

Remote - Columbia, MO

About the position

The Claims Adjuster position at Missouri Employers Mutual involves investigating, evaluating, negotiating, and settling medical claims under the guidance of the Unit Claims Manager and/or Regional Claims Manager. This professional-level role requires independent work with moderate supervision, focusing on sound claims handling techniques and adherence to company policies and statutory requirements.

Responsibilities

• Acts in accordance with MEM's vision, mission and values.
• Investigates assigned claims for coverage, promptly notifying Corporate Claims of any issues.
• Documents every claim with a coverage analysis notepad.
• Investigates assigned claims for compensability and applicable penalties according to state statutes.
• Oversees the medical aspects of the files to ensure quality care in a cost-effective manner.
• Effectively manages disability via the Return-to-Work Program, ensuring accuracy of disability payments.
• Remains alert to opportunities for surveillance to manage disability or support investigations.
• Identifies and investigates potential fraud, providing documentation for referrals to the state.
• Identifies subrogation and documents third-party liability to maximize recovery.
• Recognizes opportunities for Face-to-Face visits to investigate or minimize litigation potential.
• Establishes and maintains claim reserves sufficient to discharge corporate liability.
• Obtains medical disability ratings and negotiates settlements within approved authority levels.
• Directs attorneys in preparing claims for defense and manages legal processes throughout the claim.
• Recognizes claims with Medicare exposure and protects Medicare's interests.
• Identifies opportunities for structured settlements and negotiates accordingly.
• Documents files with all relevant facts and actions taken as required by law and company guidelines.
• Provides updates to Management on high profile or high dollar claims.
• Ensures system data integrity by maintaining accurate information.
• Prepares and presents claims for Corporate Plan of Action meetings and Account Claim Reviews.
• Maintains cross-departmental teamwork and communication with other departments.
• Provides appropriate service to internal and external customers, communicating claim status as needed.
• Manages assigned caseload effectively, prioritizing workflow tasks.

Requirements

• High School graduation or equivalent is required.
• At least one year of directly related work experience in a medical or insurance setting.
• Experience processing insurance claims is necessary.

Nice-to-haves

• A Bachelor's degree is preferred.
• AIC or other insurance designation is preferred.

Benefits

• Casual work culture
• Opportunities for professional growth
• Positive impact on workplace safety