Remote Claims Representative II Job at MEM Insurance

MEM Insurance is seeking a detail-oriented and analytical professional for its Remote Claims Representative II position. This remote insurance opportunity is designed for individuals with experience in claims handling, investigations, documentation review, compliance workflows, and customer communication.

As a Claims Representative II, you will manage moderately complex workers’ compensation claims while ensuring compliance with state regulations and company policies. The role involves reviewing medical records, analyzing statements, calculating benefits, coordinating with legal and medical professionals, and maintaining accurate claim documentation throughout the claim lifecycle.

This position offers an opportunity to transition into a more specialized operational and investigative environment within the insurance industry. Professionals with backgrounds in fraud prevention, disputes, auditing, case review, transaction analysis, or compliance may find this role highly transferable.

Key Responsibilities

• Investigate and manage workers’ compensation claims
• Review statements, medical records, and documentation
• Determine compensability and claim eligibility
• Coordinate with Nurse Case Managers and legal counsel
• Develop return-to-work strategies for injured workers
• Calculate disability benefits and maintain claim reserves
• Identify potential fraud or abuse within claims activity
• Negotiate settlements and manage litigation support
• Maintain accurate documentation and compliance records
• Collaborate with underwriting and loss prevention teams

Qualifications

• 2–4 years of claims handling experience preferred
• Workers’ compensation experience is strongly preferred
• Strong analytical and communication skills
• Experience with documentation review and compliance workflows
• Texas All-Lines Adjuster License preferred
• Associate in Claims (AIC) designation preferred

Benefits

MEM Insurance offers a competitive benefits package including:

• Medical, dental, and vision insurance
• Employer-paid life and disability coverage
• 401(k) with employer match and profit sharing
• Paid parental leave and generous PTO
• Tuition assistance and wellness incentives
• Flexible spending and health savings account options

This remote claims role is ideal for professionals seeking long-term growth in insurance operations, investigations, claims analysis, and compliance-focused careers.