Senior Claim Specialist - Albany, United States - Opportunities at MEMIC

Description

The Mission of The MEMIC Group is to make workers' comp work better with compassion, trusted partnerships, and relentless commitment to workforce safety.

The secret to the success and longevity of great organizations is their shared vision and strong values.

At MEMIC our values are to be conscientious, to be an expert, to be a partner, to be curious and to be transparent.

The Claim Specialist investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum.

(Supervisor will determine actual individual authority up to the stated maximum). Conducts training classes (including research and position papers) for less experienced Claim Department Representatives.

Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.

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 and accurate indemnity and medical benefits.
Evaluates claim exposure, negotiate and resolve claims. Works closely with defense counsel on litigated cases and attend mediation, arbitration, and hearings, as necessary.

Develops litigation plan with defense counsel and tracks adherence to plan in order to control legal expenses and assure effective resolution.

Works closely with insureds and employees making visitations and presentations as needed to facilitate partnership approach to claims handling.
Maintains quality claim files in accordance with best practices, company policy and 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 maintaining proper reserves, as appropriate.
Keeps up-to-date on State laws and Company procedures relating to various claims; educates injured worker and/or insured on same.
Prepares and presents files for Agent/Broker Reviews and Insured File Review.
Understands medical terminology and standard medical procedures as they pertain to workers compensation, U.S. Longshoremans and Jones Act claims.
Participates in in-house and outside training programs to keep up-to-date on relevant issues/topics.
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 Associate in Claims or Claims Law (AEI) courses.


Requirements:
Two years of workers compensation claim handling experience preferred.
Computer skills, Word, Excel and Image Right preferred.
Must have valid drivers license.
Strong attention to detail and strong verbal and written communication skills a must.
Must be flexible and self-directed with the ability to manage time and other resources wisely.
Adaptable/flexible and self-directed with the ability to manage time and other resources wisely.
Must have the ability to work effectively with other organizational team members.

Our comprehensive benefits package includes all traditional offerings such as:
Health Insurance options, Dental Insurance options and Vision InsuranceEmployee Life Insurance/AD&D and Dependent Life Insurance optionsShort-term & Long-term DisabilityHealth Savings Account with potential employer matchFlexible Medical and Dependent Care AccountCritical Illness InsuranceEmployee Assistance ProgramLegal/Identify Theft Insurance optionsLong Term Care InsurancePet Insurance401 (k)

Retirement Plan with match up to 5%, plus profit sharing & discretionary contributions (subject to vesting)4 weeks of Paid Time Off (PTO)7 paid holidaysWe also offer other benefits to help foster a healthy, balance lifestyle such as:
Student loan paydown and refinancing assistanceEducational assistance for job related courses, seminars, certifications or degreesOne paid day every year to volunteer for your non-profit of choiceOn-site fitness center (Maine & Virginia) or fitness reimbursementSit

• Stand desks & daily stretch breaksThe expected salary range for this position is $65,000 $110,000.

DISCLAIMER:

Based on a candidate's background and experience we are looking to hire a Claim Specialist II-IV.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.
What is the highest level of education you have completed? *Please selectIf you are under 18 and it is required, can you furnish a work permit? *Please selectAre you legally eligible for employment in this country?

• Will you now or in the future require sponsorship? * Will you relocate if the job requires it? * Will you travel if the job requires it? * Are you able to perform the 'essential functions' of the job for which you are applying (with or without reasonable accommodation)? * Please explain any terminations or gaps in experience.

If not applicable, please put N/A. *Please list the name, title, telephone number and email of 3 business references. Please indicate their relationship to you. Supervisors preferred.

*I hereby certify that the information contained in the employment application I submit to Maine Employers Mutual Insurance Company, hereinafter referred to as (MEMIC) or (the Company) is true and complete to the best of my knowledge.

I understand that material omissions or falsification of this application may result in my disqualification from consideration for employment or dismissal from employment.

I understand that my employment is subject to a satisfactory check of references.

I authorize MEMIC and/or its designees the right to investigate the information given and to secure additional information, if necessary.

I authorize my previous employers, educational institutions and all other individuals and organizations listed in this application form to provide information about my employment, work habits and character.

I agree that MEMIC, and/or its designees and my previous employers, educational institutions and all other individuals and organizations listed in this application form will not be held liable in any respect if an employment offer is not made, is withdrawn, or my employment is terminated because of furnishing necessary information incident to the employment process.

I understand that MEMIC is in no way obligated to provide employment and I am in no way obligated to accept employment, if offered.

This application does not bind either party, and the statements contained herein do not constitute and should not be interpreted to constitute any sort of contract of employment for a specific period of time.

I understand this application for employment is valid for 30 days only. Consideration for employment after 30 days requires a new application.

I understand that upon offer and acceptance of a position with MEMIC, I will be required to provide documentation establishing my identity and eligibility to be legally employed in the United States.

I understand that employment at MEMIC is employment at will. Employment may be terminated with or without cause at any time by me or by the Company.

Terms and conditions of employment with MEMIC may be modified at the sole discretion of the Company with or without cause and with or without notice, except as may be required by law.

I also understand that other than the President of the Company, no one has the authority to make any agreement for employment other than for employment at will or to make any agreement limiting the Companys discretion to modify terms and conditions of employment.

MEMIC is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a persons race, national origin, color, religion, age, gender, sexual orientation, gender identity or expression, disability, genetic information, military and veteran status, or any other protected status under applicable federal, state or local law.

If you agree to the above, please type your first and last name and today's date.

*Have you entered into an agreement with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our company? If yes, please explain.

*Have you ever been employed here before? If yes, give dates. *Have you submitted an application here before? If yes, please give date(s) and position(s).

*What is your desired annual salary or hourly rate of pay? *What is your mailing address? *Voluntary Self-Identification For government reporting purposes, we ask candidates to respond to the below self-identification survey.

Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Opportunities at MEMICs Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.

As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

Classification of protected categoriesis as follows:
A 'disabled veteran' is one of the following: a veteran of the U.S.

military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A 'recently separated veteran' means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S.

military, ground, naval, or air service.
An 'active duty wartime or campaign badge veteran' means a veteran who served on active duty in the U.S.

military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An 'Armed forces service medal veteran' means a veteran who, while serving on active duty in the U.S.

military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.Voluntary Self-Identification of Disability Form CC-305Page 1 of 1OMB Control Number Expires 04/30/2026Voluntary Self-Identification For government reporting purposes, we ask candidates to respond to the below self-identification survey.

Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in Opportunities at MEMICs Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

Gender Please select Gender Are you Hispanic/Latino? Please select Are you Hispanic/Latino? Race & Ethnicity Definitions

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.

As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA.

Classification of protected categoriesis as follows:
A 'disabled veteran' is one of the following: a veteran of the U.S.

military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A 'recently separated veteran' means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S.

military, ground, naval, or air service.
An 'active duty wartime or campaign badge veteran' means a veteran who served on active duty in the U.S.

military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An 'Armed forces service medal veteran' means a veteran who, while serving on active duty in the U.S.

military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.Veteran Status Please select Veteran Status Voluntary Self-Identification of Disability Form CC-305 Page 1 of 1 OMB Control Number Expires 04/30/2026Why are you being asked to complete this form? We are a federal contractor or subcontractor.

The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years.
Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S.

Department of Labors Office of Federal Contract Compliance Programs (OFCCP) website at .How do you know if you have a disability? A disability is a condition that substantially limits one or more of your major life activities.

If you have or have ever had such a condition, you are a person with a disability.

Disabilities include, but are not limited to:
Alcohol or other substance use disorder (not currently using drugs illegally)Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDSBlind or low visionCancer (past or present)Cardiovascular or heart diseaseCeliac diseaseCerebral palsyDeaf or serious difficulty hearingDiabetesDisfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disordersEpilepsy or other seizure disorderGastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndromeIntellectual or developmental disabilityMental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSDMissing limbs or partially missing limbsMobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supportsNervous system condition, for example, migraine headaches, Parkinsons disease, multiple sclerosis (MS)Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilitiesPartial or complete paralysis (any cause)Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysemaShort stature (dwarfism)Traumatic brain injuryDisability Status Please select Disability Status


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