Claims Consultant

Are you a highly experienced workers’ compensation claims professional who thrives on solving complex challenges, influencing outcomes, and developing others? MEM Insurance is seeking a Claims Consultant to provide technical leadership and oversight for our most complex, high-exposure claims. In this role, you will serve as a trusted advisor to claims leadership and field staff, helping ensure strong claim outcomes through effective case management, sound coverage analysis, strategic planning, and technical guidance.

As a key member of our Claims team, you will lead reviews of high-severity claims, conduct audits to identify best practices and opportunities for improvement, provide coaching and mentoring to claims professionals, and play an important role in shaping policies, procedures, and training initiatives. This position offers the opportunity to make a meaningful impact on both claim outcomes and the professional development of claims staff across the organization.
Essential Duties and Responsibilities

- Provide technical oversight and strategic direction on complex and high-exposure workers’ compensation claims, ensuring appropriate investigations, reserving, evaluation, litigation management, and settlement strategies.

- Conduct monthly Plan of Action (POA) meetings and claim reviews for high-exposure claims, generally involving exposures exceeding $500,000, while providing guidance regarding claim strategy, reserve adequacy, and critical claim management decisions.

- Investigate, manage, and resolve complex coverage matters, including questionable coverage claims, potential no-coverage scenarios, Employers Liability claims, and related litigation.

- Partner with claims leadership and coverage counsel to develop solutions for challenging coverage disputes and litigation matters.

- Conduct comprehensive claim reviews on files with significant incurred values and provide recommendations that support effective claim resolution and favorable outcomes.

- Lead CARE Reviews (Claims Audits) to evaluate claim quality, identify best practices, monitor operational performance, and uncover opportunities for improvement throughout the claims organization.

- Analyze audit findings and operational trends, providing actionable feedback and recommendations to claims leadership to improve performance and drive consistency.

- Deliver coaching, mentoring, and technical guidance to field claims professionals and managers on workers’ compensation coverage, compensability determinations, litigation management, and claim-handling best practices.

- Support the development and delivery of training programs for claims personnel, promoting continual learning, technical excellence, and professional growth.

- Provide technical oversight and consultation on Argonaut Insurance claim activities, including claim reviews, reserve evaluations, settlement authority reviews, audits, and special projects.

- Research emerging claim issues and develop jurisdiction-specific training and resources to support business expansion into new states and markets.

- Conduct Burn Rate Reviews of open, high-exposure claims to ensure timely identification of trends, risks, and opportunities for intervention.

- Collaborate with senior claims leadership to develop, refine, and maintain claims policies, procedures, and operational best practices.

- Prepare reports, analyses, and recommendations for claims leadership, summarizing findings, trends, and opportunities across the claims operation.

- Organize and prioritize work effectively while managing multiple projects, assignments, and deadlines in a fast-paced environment.

Qualifications

- Bachelor's degree in Business, Insurance, Risk Management, or a related field preferred.

- AIC (Associate in Claims) designation preferred.

- SCLA (Senior Claims Law Associate) designation preferred.

- CSRP (Certified Subrogation Recovery Professional) designation preferred.

- Claims Adjusting License preferred.

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