Policyholder Services Representative I (Remote)

Are you a seasoned claims professional with a passion for navigating complex cases? MEM Insurance is seeking a Senior Claims Representative to join our Claims team. In this pivotal role, you’ll manage high-exposure workers’ compensation claims, lead investigations into coverage and fraud, and collaborate across departments to drive strategic outcomes. You’ll be a key decision-maker, a mentor to junior adjusters, and a champion of process improvement—all while ensuring exceptional service and regulatory compliance.   At MEM Insurance, we don’t just protect our customers—we empower our employees. We foster a culture of integrity, collaboration, and innovation. Our team thrives on solving challenges together, supporting one another, and making a meaningful impact in the lives of our policyholders and injured workers.   ----------------------------------------------------------------------------------------------------------------------------------     Essential Duties and Responsibilities: Claims Handling & Administration * Manage highly complex claims involving significant financial exposure, legal intricacies, and extended life cycles. * Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations. * Oversee medical case management for catastrophic injuries and lifetime care needs. * Review and authorize large or complex medical bills, negotiating adjustments to control costs. Return-to-Work Management * Develop comprehensive RTW strategies in collaboration with policyholders, legal counsel, and vocational consultants. * Ensure precision in benefit calculations for high-exposure claims, addressing tax and compliance risks. * Strategically deploy investigative efforts aligned with broader claims strategy. Claims Investigation & Loss Prevention * Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit. * Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery. Settlements & Negotiation * Partner with legal teams to negotiate complex settlements and manage litigation processes. * Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement. * Identify opportunities for structured settlements and lead negotiations. Reporting * Produce strategic reports on high-profile claims to guide management decisions. * Maintain system data integrity and prepare claims for Corporate Plan of Action meetings. Collaboration * Lead cross-departmental efforts to improve claims handling and risk management. * Resolve escalated customer service issues and support high-value accounts. * Participate in workflow improvement initiatives and committees. Team Leadership * Mentor and coach junior and intermediate adjusters. * Review escalated claims and provide actionable feedback. * Support workforce development and succession planning.   Qualifications: * Bachelor’s degree in business or related field preferred, or equivalent industry experience. * 7–10 years of claims handling experience, with high exposure to Workers’ Compensation. * Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain. * Texas All-Lines license preferred. * Valid driver’s license required.   ----------------------------------------------------------------------------------------------------------------------------------   COMPANY CULTURE AND VALUES At MEM Insurance, we are committed to our vision, mission, and values. We foster a culture of collaboration, integrity, and innovation. Our team is passionate about delivering exceptional service to our customers while supporting each other’s growth and success. We believe in accountability, continuous learning, and creating an environment where employees feel valued and empowered.   ----------------------------------------------------------------------------------------------------------------------------------   CONNECTION AND BELONGING MEM Insurance is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We believe that varied perspectives drive innovation and strengthen our ability to serve our customers and communities.   ----------------------------------------------------------------------------------------------------------------------------------   TOTAL REWARDS OVERVIEW * Health Plans: Medical, Dental, and Vision Includes fertility benefits, fully paid preventative care, and adult orthodontia. * Employer-Paid Life and Disability Benefits: Life Insurance (3x base salary), AD&D, Short and Long-term Disability. * Wellness and Recognition Program: Employer-paid incentives for employees and spouses. * Flexible Spending Account and Dependent Care options * Health Savings Account: Generous employer contribution. * Time Away from Work: Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave. * Employee Assistance Programs * 401k Retirement Plan: Employer match and profit sharing. * Adoption Assistance and Tuition Assistance   ----------------------------------------------------------------------------------------------------------------------------------   Notice Regarding Use of Artificial Intelligence MEM may use artificial intelligence (AI) tools to more efficiently facilitate and assist in decisions involving recruitment, hiring, promotion, renewal of employment, selection for training or apprenticeship, discharge, discipline, tenure, or the terms, privileges, or conditions of employment. Any such use of AI tools will comply with all applicable laws.

The Opportunity:  At Equitable, we believe great things happen when we work together. We’re a Canadian mutual company driven by purpose - putting people first and helping Canadians protect today and prepare for tomorrow. If you’re passionate about making a difference and growing your career in an inclusive and collaborative environment, we’d love to hear from you. Our culture is built on care, passion and curiosity. We put people above all else, strive to be our best and welcome new ideas to deliver positive outcomes.   We are looking for a Document Services Administrator to join our Corporate Document Centre team! This role will be responsible for ensuring that all incoming documentation to Equitable is received by the appropriate business area in a timely manner, through both electronic (Image) environment, and manual delivery. This will include ensuring outgoing mail is collated, sorted and sent via the appropriate channel (Courier, Canada Post) within prescribed timelines and being accountable for securing, processing bank deposits, and maintaining inventory of all incoming cheques and cash to Equitable and completion of all required audits. Join one of the region’s top employers and be part of something that truly makes a difference. Work Arrangements: This is an in-office role. You will work in our office in Waterloo, ON 100% of the time. What you’ll do: * Know and perform 50+ different work processes * Open, identify and organize all documents entering Document Services * Open mail, and immediately assess, prep and scan documents – requires detailed knowledge of each business area and their differing requirements for forms. (200+ different documents); * Scan all documents and review images for quality control * Using multiple systems (KTM, OnBase, Outlook).  Electronically code/name each image (validation) ensuring excellent accuracy on data entry.  EZ Upload requires going to external sources such as R drive to ensure accuracy of electronic files being uploaded * Review documents and make decisions on how to split apart based on business rules * Accountable for securing, processing bank deposits, and maintaining inventory of all incoming cheques and cash to Equitable * Completion of multiple daily audit procedures for Money In, returned mail processing * Address changes requiring extensive investigation of owner and insured records on multiple systems, (Ingenium, Unitrax, Vax), with correspondence to Advisor of record * Prepare client contracts for mail out.  Includes Audit of print from IT Operations, Appropriate sorting of contracts for delivery to business or mailing; binding contracts, final QA check on completeness of client contract mailing. * Build test cases for Project implementations * Complete testing of new forms or processes for IT project implementations * Collate mailings, stuffing of envelopes (manually and by machine) for mail out * Problem solve/provide support for all Equitable business teams (OnBase issues, original retrieval, mail delivery questions and issues) * Pulling and re-filing of client records, paper and microfiche files * Miscellaneous administrative functions within the department (welcome letters, VAX contracts, scanned apps, dashboards, etc.) * Create/follow and improve established processes, procedures and established standards to ensure the stability of the environment with minimal disruption to the business * Data Centre Facilities - Share responsibility for the operation, maintenance and security of data centre facilities, systems and data * Shares responsibility for managing vendor relationships – including issue resolution and service level management * Routinely provides stakeholders with status updates on service issues * Responsible for ensuring Print processes are in control and output is in proper order following any issues that occur.  Preventative measures to ensure reduced risk of privacy breaches.      What you’ll bring: * Good communication skills; both verbal and written; * Attention to detail, with an ability to identify when processes are not working appropriately; * Sound working knowledge of MS Office, Windows/Word; Excel, Adobe Acrobat, Internet and keyboarding skills; * Ability to learn and apply new system applications; * Learn various internal systems such as: Ingenium, BMS, Unitrax and VAX policyholder system, FASAT, salesforce system, KOFAX, OnBase Client, OnBase Scan, FASAT and KTM software programs; * Work with Purolator, ICS and Canada Post delivery systems; * Previous experience with operation of various scanning hardware: OPEX, VIDAR and KOFAX is an asset; * Previous operation and maintenance of Microfiche machine and supplies is an asset; * Knowledge of FAX and copier functions, including clearing of problems is an asset; * Excellent data entry skills with the ability to process high volumes under strict timelines; * Strong organizational skills with attention to detail, to ensure work is sent to the correct business workflow; * Ability to problem-solve and make decisions on ambiguous documentation; * Ability to multitask in a fast-paced environment; * Ability to work effectively in team environment; * Knowledge and application of document types (200+) for all lines of business, corporate and operational; * Ability to deliver efficient and responsive customer service including some client correspondence to Equitable business units and MGAs/Advisors; * Punctuality; and * Confidentiality of all client records and documentation. What’s in it for you: * Career Growth: Regular learning sessions and development opportunities * Total Rewards: Allowance provided in place of vacation pay and benefits * Flexibility: Healthy work-life balance with employee wellness always top of mind, complemented by a “dress for your day” approach   At Equitable, we’re committed to fair pay and an inclusive, accessible hiring experience. If you need accommodations or alternative formats at any stage, just reach out to us at careers@equitable.ca [careers@equitable.ca]. We’re happy to help.   Your base pay will be based on your skills, qualifications, experience and education.   If you’re selected to move forward, our Talent Acquisition team will walk you through all the details of our total rewards program, so you know exactly what’s included.   Reports To: Supervisor, Document Services Department: Corporate Services Term:  Temporary Full-Time, Six (6) Month Contract