Associate Claim Specialist
Job Overview
Location
New York
Company
MEMIC – Trusted Workers’ Compensation Insurance Provider
About MEMIC
At MEMIC, our mission is to make workers’ compensation insurance better—through compassionate service, trusted partnerships, and an unwavering focus on workplace safety. Our core values—Be Conscientious, Be an Expert, Be a Partner, Be Curious, and Be Transparent—guide everything we do. For over 30 years, MEMIC has helped businesses protect employees, reduce workplace injuries, and deliver exceptional claims services.
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).
Principal Duties and Responsibilities
* 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.
Minimum Knowledge, Skills and Abilities
1. No previous experience needed; on-the-job training provided.
2. Proficient in Microsoft Office (Word and Excel).
3. Must have valid driver’s license.
4. Strong attention to detail and strong verbal and written communication skills a must.
5. Must have flexibility and be self-directed with ability to manage time and other resources wisely.
6. Must have the ability to work effectively with other organizational team members.
7. 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.
Why Join MEMIC?
- Health & Wellness: Medical, dental, vision insurance, plus fitness reimbursement.
- Financial Security: 401(k) with up to 5% match, profit sharing, and life insurance.
- Paid Time Off: Four weeks PTO and 11 paid holidays.
- Education & Growth: Tuition reimbursement and professional development opportunities.
- Work-Life Balance: Flexible schedules and a paid volunteer day annually.
Work Conditions:
1. Normal office environment with minimal exposure to excessive noise and temperature variations.
2. Willingness to travel among company sites as needed.
3. Will be required to stand and/or sit for extended periods.
4. Will be required to work with Video Display Terminal.
5. May be required to do occasional reaching and bending.
6. May be required to occasionally exert physical effort (lifting/carrying) using appropriate equipment if needed.
7. May be required to work overtime.
8. Full-time required.
Join MEMIC Today!
Ready to make an impact in workers’ compensation insurance? Apply now and bring your expertise to MEMIC—where safety and compassion are at the heart of everything we do.
The expected salary for this position is $56,000.
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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