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 II investigates, evaluates, negotiates, and resolves lost time claims and medical-only 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.

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 appropriate best practices, and other company procedures.
Implements Managed Care strategies, coordinate rehabilitation or medical management, process bills, review all mail through Image Right, and monitor 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 worker’s compensation, U.S. Longshoreman’s 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 to handle 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.
Bachelor’s degree preferred.
Computer skills, Word, Excel and Image Right preferred.
Must have valid driver’s license.
Strong attention to detail and strong communication skills both verbal and written.
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 Insurance
Employee Life Insurance/AD&D and Dependent Life Insurance options
Short-term & Long-term Disability
Health Savings Account with potential employer match
Flexible Medical and Dependent Care Account
Accident Insurance
Critical Illness Insurance
Employee Assistance Program
Legal/Identify Theft Insurance options
Long Term Care Insurance
Pet Insurance
401 (k) Retirement Plan with match up to 5%, plus profit sharing & discretionary contributions (subject to vesting)
5 weeks of Paid Time Off (PTO)
10 paid holidays

We also offer other benefits to help foster a healthy, balance lifestyle such as:

Flextime schedules
Paid Parental Leave
Student loan paydown and refinancing assistance
Educational assistance for job related courses, seminars, certifications or degrees
One paid day every year to volunteer for your non-profit of choice
On-site fitness center (Maine & Virginia) or fitness reimbursement
Subsidized parking
Sit-Stand desks & daily stretch breaks

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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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 Company’s 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 person’s 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. *

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