Claims Analyst II

Company Details

Why MEC?

At Midwest Employers Casualty (MEC), we combine the stability of a Fortune 500 company with the agility of an innovative team. We are passionate about improving the quality of life for employees severely injured on the job and helping companies understand and mitigate risk. Our culture values collaboration, curiosity, and continuous learning. If you want to make an impact, work on meaningful projects, and grow your career in a supportive environment, MEC is the place for you.

Company URL: https://www.mecasualty.com

Responsibilities

The Claims Analyst II is responsible for managing high-exposure Workers Compensation claims. The primary job objectives are to proactively mitigate loss costs and settle claims by developing relationships and influencing MEC’s customers and claim administrators. The role also leverages Advanced Analytics and Assisted Intelligence (A.I.) tools to enhance claim evaluation, reserve accuracy, and settlement strategies, supporting data-driven decision-making and continuous improvement. 

Key functions include but are not limited to:

• Accurately evaluate WC claims for potential exposure and establish appropriate reserves
• Utilize predictive analytics and A.I. driven tools to provide insight into complex medical issues, evaluate trends and explore potential exposures
• Lead evaluation, mitigation and resolution of WC claims by collaboration with MEC Medical Management Consultants, Client Consult Managers and Claims Attorneys
• Achieve settlement and vendor goals and objectives
• Adhere to departmental Best Practices by: 
  • Establishing, reviewing and adjusting case reserves in a timely manner within proper authority levels supported by data driven insights and A.I. assisted tools.
  • Identifying and influencing appropriate MEC vendors
  • Identifying and achieving claim settlement agreements and obtaining necessary authority to finalize resolution
  • Maintaining well documented claim files supported by an effective and current diary system on all assigned claims
• Influence TPA adjusters to adopt MEC recommended claim handling strategies
• Plan and conduct on-sight Third Party Administrators (TPAs) visits to promote loss mitigation, vendor utilization and timely settlement across assigned portfolio of claims
• Collaborate with Regional Team colleagues to support business growth and client retention through consultative engagement
• Review and authorize reimbursements

Qualifications

• Bachelor's in general studies, liberal arts or business.
• Requires a minimum of five years of California Workers’ Compensation experience obtained within the past eight years, or successful passage of the California Self‑Insurance Exam with consistent employment following certification.
• Frequent usage and general knowledge of WC industry accepted claim handling practices and standards with a minimum of 5 years of primary claim handling experience.
• High level of influence management skills.
• Ability to prioritize, organize and meet deadlines.
• Ability to analyze issues and barriers, find solutions and effectively implement solutions.
• Ability to work effectively in a team environment under general supervision.
• Ability to communicate frequently and effectively to internal and external contacts using both verbal and written communication skills.
• Ability to learn and maintain skill levels in an electronic environment.
• Working toward CPCU or AIC credentials preferred.

Additional Company Details

We do not accept any unsolicited resumes from external recruiting agencies or firms. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.

Sponsorship Details

Sponsorship not Offered for this Role

Responsibilities

The Claims Analyst II is responsible for managing high-exposure Workers Compensation claims. The primary job objectives are to proactively mitigate loss costs and settle claims by developing relationships and influencing MEC’s customers and claim administrators. The role also leverages Advanced Analytics and Assisted Intelligence (A.I.) tools to enhance claim evaluation, reserve accuracy, and settlement strategies, supporting data-driven decision-making and continuous improvement. 
Key functions include but are not limited to:
- Accurately evaluate WC claims for potential exposure and establish appropriate reserves
- Utilize predictive analytics and A.I. driven tools to provide insight into complex medical issues, evaluate trends and explore potential exposures
- Lead evaluation, mitigation and resolution of WC claims by collaboration with MEC Medical Management Consultants, Client Consult Managers and Claims Attorneys
- Achieve settlement and vendor goals and objectives
- Adhere to departmental Best Practices by: 
- Establishing, reviewing and adjusting case reserves in a timely manner within proper authority levels supported by data driven insights and A.I. assisted tools.
- Identifying and influencing appropriate MEC vendors
- Identifying and achieving claim settlement agreements and obtaining necessary authority to finalize resolution
- Maintaining well documented claim files supported by an effective and current diary system on all assigned claims

- Influence TPA adjusters to adopt MEC recommended claim handling strategies
- Plan and conduct on-sight Third Party Administrators (TPAs) visits to promote loss mitigation, vendor utilization and timely settlement across assigned portfolio of claims
- Collaborate with Regional Team colleagues to support business growth and client retention through consultative engagement
- Review and authorize reimbursements