Litigation Specialist (Remote)

Are you driven to keep people safe? That’s what we do every day at MEM Insurance.

We’ve created a casual, values-driven work culture that’s making a positive impact on the way people live and work. This is a place where you can grow with confidence — because that’s what safety and success really mean to us.

SUMMARY:

The Litigation Specialist is an advanced-level position responsible for managing and resolving moderate to highly complex , high-exposure litigated claims involving significant financial, legal, and reputational risks. This role requires expertise in evaluating claims strategy, directing litigation in collaboration with defense counsel, and resolving issues such as Medicare compliance, future medical projections, and structured settlements. The Litigation Specialist independently develops, implements, and leads Settlement Day and Special Mediation strategies across multiple regions, coordinating with claims staff, counsel, and other stakeholders to achieve corporate closure goals. Acting as a resource and mentor, this position provides expert guidance to less experienced adjusters, contributes to strategic claim reviews, and ensures adherence to statutory requirements and company claims philosophy. The ability to manage a challenging caseload with minimal supervision, exercise sound judgment, and deliver quality outcomes is critical to success in this role . This position will work closely with defense attorneys, medical providers, and internal stakeholders to ensure efficient and fair claim handling.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily . The requirements listed below are representative of the knowledge, skill, and/or ability required . Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions .

Litiga tion File & Case Management

• Manage caseload of complex, high-exposure litigated claims across multiple jurisdictions , pursuant to department guidelines, with management-level authority. Caseload includes toxic exposure cases, claims involving permanent total disability (PTD) allegations, disputed/litigated fatality cases, and disputed/litigated coverage cases. Identify cases with possible allegations of enhanced benefits.
• Manage cases involving multiple employers and/or employment concerns. Identify cases with coverage concerns and collaborate with the Technical Services Unit to resolve conflict issues or cases involving civil liability.
• Direct litigation strategy and collaborate with counsel in the defense of assigned caseload. Determine if expert evaluations or vocational opinions are necessary for claims with PTD exposure.
• Identify and resolve all case issues, including future medical concerns, Medicare issues, and liens . Obtain future medical projections and Medicare Set-Aside proposals as necessary.
• Identify opportunities for structured settlements of indemnity and medical benefits. Work with counsel to determine exposure estimates and maintain accurate reserves as discovery progresses.
  
  
  

Settlement and Mediation

• Solely responsible for achieving the Claims Department goal for Settlement Days and Special Mediation settings. Act as the educator and leader for these settings by coordinating schedules, encouraging participation, identifying appropriate cases , negotiating with multiple parties, and reporting results to management. Parties include claims representatives, defense counsel, plaintiff counsel, judges, second-injury fund representatives, injured workers, and mediators.
  
  
  

Medicare Compliance and Expertise

• Serve as a specialist resource on Medicare issues across multiple claim regions. Determine when Medicare Set-Asides (MSAs) and CMS approvals are required , communicate with CMS and Medicare vendors on MSA proposals and Conditional Payments, and finalize settlements in compliance with Medicare guidelines.
• Assist with questions regarding rated ages, annuity quotes, and professional administration of Medicare Set-Aside proposals.
  
  
  

Lifetime Medical Claims Management

• Manage claims with open lifetime medical exposure, ensuring appropriate ongoing medical care while controlling costs.
• Monitor long-term medical treatment plans and ensure medical necessity.
• Negotiate cost-effective resolutions, including structured settlements where appropriate .
• Collaborate with nurse case managers, medical providers, and other stakeholders to optimize care plans.
  
  
  

File Management and Reporting

• Maintain a diary of potential file reassignments, prioritizing based on discovery status, case complexity, representative experience, and departmental staffing needs.
• Present toxic exposure cases and cases with possible enhanced benefits in annual Enhanced Benefit Plan of Action Meetings. Provide legal plans of action, reserve recommendations, and resolution strategies, documenting file plans following the meetings.
  
  
  

Mentorship and Team Leadership

• Identify opportunities to mentor and assist less experienced claims representatives, including collaboration on cases involving future medical issues, large exposures, and reserve recommendations.
• Provide recommendations on litigation plans of action and the use of experts. Assist with conditional payment liens, psych allegations, assault cases, and catastrophic claims requiring home or vehicle modifications.
• Provide expert analysis in monthly Plan of Action Meetings, contributing insights on medical status, legal strategy, reserve recommendations, and resolution strategies for complex files.
  
  
  

QUALIFICATIONS:

Education

• Bachelor’s degree in business or related field preferred or a combination of industry work experience
  
  
  

Designations/Certifications

• Associate in Claims ( AIC ) or other insurance designation is preferred or the ability to obtain
• AIM preferred
• CPCU designation preferred
  
  
  

Licenses

• Texas -All Lines Preferred
• A valid drivers’ license is required .
  
  
  

Experience

• 8 years of claims handling experience : including investigation, evaluating, and negotiating settlements of workers compensation claims
  
  
  

TOTAL REWARDS:

• Health Plans: Medical, Dental, and Vision
• Our medical plan includes robust offerings such as fertility benefits and fully paid preventative care.
• Our dental coverage also includes adult orthodontia, and other less commonly covered dental treatments.
• Fully Employer-Paid Life and Disability Benefits
• Life Insurance - three times base salary
• Accidental Death and Dismemberment
• Short and Long-term Disability
• Employee Wellness and Recognition Program with employer-paid incentives for employees and their spouses
• Flexible Spending Account and Dependent Care options
• Health Savings Account with generous employer contribution
• Time Away from Work
• Generous PTO accruals
• 11 Holidays and 4 Early releases
• 16 Hours of Volunteer Time Off
• 20 days of paid parental leave (in addition to STD)
• Marriage, Bereavement, and Jury Duty leave policies
• Employee Assistance Programs
• 401k Retirement Plan including employer match and profit sharing
• Adoption Assistance
• Tuition Assistance
  
  

Our home office is located in vibrant Columbia, Missouri — #6 in Livability’s 2019 Best Places to Live .

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