Claims Examiner - Workers Compensation

Maxim Healthcare Services, Inc.; Columbia (MD); Hybrid; USD 42,000 - 54,000; Full time

Benefits offered by this job

Health & Wellness

Retirement Plan

Paid Time Off

Educational Assistance

Job summary

Maxim Healthcare Services, Inc. in Columbia, MD, is seeking a WC Claims Examiner I to manage the Workers’ Compensation claim process. The role involves working with TPAs, providers, attorneys, and internal teams to develop and execute claim handling plans in a hybrid office environment.

The ideal candidate will have at least 3 years of WC experience, a relevant degree, strong organizational and communication skills, and the ability to work independently or as part of a team.

Qualifications

• Bachelor's degree in business, human resources, or related field preferred.
• At least 3 years of Workers’ Compensation experience.
• Legal experience strongly preferred.
• Strong organizational and communication skills.

Responsibilities

• Brings pending and new WC claims to resolution.
• Participates in calls with TPAs, providers, attorneys, and other Maxim team members to plan handling.
• Monitors TPA files and ensures legal deadlines are met.
• Educates branch offices about workers compensation.
• Provides excellent customer service to employees.

Skills

Communication

Organizational skills

Teamwork

Customer service

Independence

Education

Bachelor's degree in business, human resources, or related field

Tools

Microsoft Office

Job description

Claims Examiner Workers' Comp

Location - Columbia, MD - Hybrid

Pay Range: $20.00 - $24.00 + $4,000 annual bonus potential

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.

#LI-KF1

Maxim Benefits:

Health and Wellness
Medical/Prescription, Dental, Vision, Health Advocacy (company paid if enrolled Medical) and Health Advocate Employee Assistance Program

Retirement and Financial Security:
Employee Assistance Program, Health Savings Account, 401(k) + Company Match, Profit Sharing, Short and Long Term Disability, Primary Caregiver Leave, Parental Leave, Life and Basic Accidental Death & Dismemberment Insurance, Voluntary Group Life Insurance and Supplemental Accidental Insurance, Hospital Expense Protection Plan, Critical Illness Insurance, Dependent Care Flexible Spending Account, Home and Auto Insurance discounts, Pet Insurance and Legal benefits

Lifestyle Benefits:
Paid Time Off and Company Paid Holidays, Transportation Benefits, Educational Assistance Program, College Partnership Program and Employee Discount Program

*Benefit eligibility is dependent on employment status.

About Maxim Healthcare:

Maxim Healthcare 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, Inc. (“Maxim”) is an equal opportunity 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.