Workers' Compensation Claims Examiner II

4 weeks ago

Columbia, United States Maxim Healthcare Full time

The Workers' Compensation (WC) Claims Examiner II understands and participates in every aspect of the WC claim process. Working in a team approach, the WC Examiner II will make decisions concerning reserve adjustments, develop a plan of action, and determine the appropriate settlement value. The WC Claims Examiner II also works with the In-take Coordinators, the broker of record, the WC Manager and fellow Maxim co-workers at every level of the business.

Essential Duties and Responsibilities:

* Manages and resolves new, pending, and litigated workers compensation files
* Participates in and leads conference calls with local offices, third-party administrators (TPAs), medical providers, attorneys, and other Maxim team members
* Monitors TPA's file resolution plans
* Ensure legal deadlines are met
* Represents Maxim in depositions, mediation, and conference calls regarding assigned claim files
* Provides, reviews and comments on the financial aspects of assigned claims files
* Educate branch offices about all aspects of Workers' Compensation
* Provides excellent customer service to injured employees
* Guides and advises Intake Coordinators and handles work overflow when necessary
* Prepares WC claim reports for review by department management team
* Reviews, identifies and make recommendations for maintaining control and/or reducing the claims experience (loss history) of the company
* Assists Manager in achieving overall department goals
* Performs other duties as assigned/necessary

Minimum Requirements:

* College degree preferred; or equivalent work experience
* Five to Seven years of Workers' Compensation experience preferred
* Some legal experience strongly preferred
* Good organizational skills and attention to detail
* Ability to work independently and cooperatively in a team environment
* Ability to communicate effectively and provide excellent customer service with individuals at all levels of the organization
* Computer proficiency, including Microsoft Office applications, required
* Prior experience performing internet research
* Ability to effectively elicit/provide information to and from appropriate individuals (including, but not limited to, supervisors, co-workers, clients) via strong communication skills; proficiency in the English language may be required
* Flexible work hours such that over time can be worked if needed

Benefits

At Maxim Healthcare Services, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits:

* Competitive pay & weekly paychecks
* Health, dental, vision, and life insurance
* 401(k) savings plan
* Awards and recognition programs

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.

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