The Workers’ Compensation (WC) Claims Examiner I participates in every aspect of the WC claim process. Working independently and in coordination with other WC team members, the WC Examiner I will consult with the WC Manager regarding reserve adjustments, a plan of action, and the appropriate settlement value of assigned claim files. The WC Claims Examiner I also works with the In-take Coordinators, other Claim Examiners in the department, the third party administrator, the WC Manager and fellow Maxim co-workers in the execution of company business.
Essential Duties and Responsibilities:
- Brings pending and new WC claims including those that are litigated, to resolution.
- Participates in calls with local offices, third-party administrators (TPAs), medical providers, attorneys, and other Maxim team members, in order to agree upon, communicate, and execute claim handling plans.
- Monitors TPA files.
- Ensures legal deadlines are met.
- Maintains WC Department Legal Calendar.
- Participates in depositions, mediations, and calls regarding assigned claim files.
- Reviews and comments on the financial aspects of assigned claim files.
- Educates branch offices about workers compensation.
- Provide excellent customer service to all employees.
- Helps identify patterns developing from injuries and resulting in WC claims.
- Helps to track claims and run reports for management.
- Makes recommendations for improving the WC claim process reducing overall claim counts.
- Performs other duties as assigned
Minimum Requirements:
- Bachelors degree in business, human resources, or related field preferred.
- At least 3 years of Workers’ Compensation experience.
- Legal experience strongly preferred.
- Good organizational skills and attention to detail.
- Ability to work in a fast-paced environment.
- Be able to work independently and as part of a team.
- Ability to communicate effectively and provide excellent customer service with individuals both inside and outside of the organization.
- Computer proficiency, including Microsoft Office applications, required.
Wage/Salary Information:
$20.00 - $23.00 per hour, with a $3,000 - $7,000 annual bonus potential
About Maxim Healthcare Services
Maxim Healthcare Services has been making a difference in the lives of our patients, caregivers, employees and communities for more than 30 years. We offer private duty nursing, skilled nursing, physical rehabilitation, companion care, respite care and behavioral care for individuals with chronic and acute illnesses and disabilities. Our commitment to quality customer service, compassionate patient care, and filling critical healthcare needs makes us a trusted partner wherever care is needed.
Maxim Healthcare Services is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.
