Claims Specialist IV

Posted 2 Hours Ago
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Portland, ME, USA
In-Office
Mid level
Insurance
The Role
Manage the full lifecycle of complex lost-time workers' compensation claims: investigate, evaluate, negotiate, settle, and reserve within authority. Ensure compliance with state WC laws, coordinate with counsel, medical providers and vendors, develop resolution strategies, and mentor/train junior adjusters while serving as a subject-matter expert.
Summary Generated by Built In
We’re looking for a seasoned Claim Specialist IV to take ownership of complex lost time claims while serving as a mentor and subject matter expert within our Claims team. This is a high-visibility role designed for a skilled professional who thrives in a fast-paced environment, exercises sound judgment, and enjoys elevating the capabilities of others. The Claim Specialist IV investigates, evaluates, negotiates, and resolves lost time claims within settlement and reserving authority up to stated maximum. Based on experience and proven ability, an expanded and more difficult caseload will be expected, requiring a lesser degree of supervision.
This position can be remote, hybrid or in-personWhat You’ll Do
  • Own the full claim lifecycle: Investigate, evaluate, negotiate, and resolve lost time workers’ compensation claims within designated settlement and reserving authority
  • Analyze complex exposures: Assess compensability, medical, legal, and indemnity factors while proactively managing risk and claim cost drivers
  • Navigate jurisdictional requirements: Ensure compliance with state-specific WC laws, litigation processes, and regulatory guidelines
  • Strategically manage claims: Develop and execute resolution strategies, including collaboration with defense counsel, medical providers, and vendors
  • Exercise advanced judgment: Handle a high-exposure, complex caseload with a high degree of autonomy and limited supervision
  • Develop others: Design and deliver training sessions, research materials, and technical guidance for less experienced adjusters
  • Serve as a subject matter expert: Provide leadership in best practices, reserving, settlement strategy, and claim handling excellence
What Sets This Role Apart
  • Complex, high-impact caseload: Manage litigated and non-litigated lost time claims requiring deep technical expertise 
  • Expanded authority: Settlement and reserving authority aligned with your experience and demonstrated capabilities
  • Influential role: Shape claim outcomes and elevate team performance through mentorship and knowledge sharing
  • Cross-functional exposure: Regular collaboration with legal, medical management, underwriting, and risk partners
 What You Bring
  • Proven experience managing lost time claims with increasing complexity - 4 years of WC lost time claim handling required
  • Strong negotiation and analytical skills with a focus on resolution
  • Ability to work independently while maintaining high-quality outcomes
  • Passion for mentoring, training, and knowledge sharing
  • Demonstrated ability to handle confidential, high-impact situations with professionalism

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. Additionally, we are committed to providing an inclusive and accessible recruitment experience for all candidates. If you need a reasonable accommodation during the interview process, please contact us at [email protected]

To ensure an equitable and authentic interview process, candidates should not use AI or chatbot tools during the live interview or phone screen. We welcome any preparation you choose to do beforehand, but all responses shared during the interview must be your own.

Note: MEMIC does not offer Stem-OPT EAD Extension for this role.

Check out our benefit offerings here! Targeted salary range: ___________

Skills Required

  • 4 years of workers' compensation lost time claim handling experience
  • Proven experience managing complex and litigated lost time claims
  • Knowledge of state-specific workers' compensation laws, litigation processes, and regulatory guidelines
  • Settlement and reserving authority experience and judgment in high-exposure claims
  • Strong negotiation and analytical skills focused on resolution
  • Ability to work independently with limited supervision
  • Experience collaborating with defense counsel, medical providers, and vendors
  • Experience mentoring, designing, and delivering training or technical guidance
  • Ability to handle confidential, high-impact situations professionally
Am I A Good Fit?
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The Company
HQ: Portland, ME
459 Employees
Year Founded: 1993

What We Do

A super-regional workers’ compensation specialty insurer rated “A” (Excellent) by A.M. Best, The MEMIC Group insures more than 20,000 employers and their estimated 300,000 employees. Licensed across the country with more than $1.4 billion in assets, The MEMIC Group is a leading carrier in the Northeast with a growing profile down the Eastern Seaboard. Offices are located in New Hampshire, Connecticut, New York, New Jersey, Pennsylvania, Virginia and Florida, in addition to the headquarters in Portland, Maine. In 2018, The MEMIC Group will have written more than $400 million in premium, a growth of more than 5.5% from 2017 and part of a 70% increase over the past 5 years.

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