Workers' Compensation Claims Examiner

Amergis Healthcare Staffing; Columbia (MD); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical/Prescription

Dental

Vision

401(k) Company Match

Paid Time Off

Job summary

Amergis Healthcare Staffing is seeking a Claims Examiner in the Workers’ Compensation domain to manage full cycle claim processes and resolve claims across assigned states. You will collaborate with local offices, TPAs, and providers to communicate status plans and ensure deadlines are met.

The role requires 5–10 years WC experience, strong organizational skills, and proficient use of Microsoft Office. You will work independently within a team, providing excellent customer service to injured

Qualifications

• College degree preferred; or equivalent work experience.
• 5 to 10 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 is required

Responsibilities

• Manages full cycle claim management for assigned states to resolution
• Participates in conference calls with local offices, third-party administrators (TPAs), medical providers, and other Amergis employees in order to communicate status plans
• Ensures legal deadlines are met
• Monitors TPA’s file resolution plans
• Represents Amergis in depositions, mediation, and conference calls regarding assigned claim files
• Provides analysis on the financial aspects of assigned claims files
• Provides excellent customer service to injured workers
• Prepares WC claim reports for department management team
• Reviews, identifies and makes recommendations for maintaining control and/or reducing the claims experience (loss history) of the company
• Authorizes or revise reserve requests
• Coordinates with Benefits team during employee’s absence
• Coordinates with state programs and internal departments for transitional duty
• Educates branch offices about all aspects of Workers’ Compensation
• Assists Manager in achieving overall department goals
• Performs other duties as assigned/necessary

Skills

Strong communication

Organizational skills

Team player

English proficiency

Independent worker

Education

College degree preferred or equivalent

Tools

Microsoft Office

Job description

Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions.

The Claims Examiner Workers’ Comp understands and participates in every aspect of the WC claim process. Working in a team approach, the Claims Examiner WC will make decisions concerning reserve adjustments, develop a plan of action, and determine claim resolution. The Claims Examiner WC also works with the Adjusters, WC Manager, and fellow Amergis team members.

Essential Duties And Responsibilities

• Manages full cycle claim management for assigned states to resolution
• Participates in conference calls with local offices, third-party administrators (TPAs), medical providers, and other Amergis employees in order to communicate status plans
• Ensures legal deadlines are met
• Monitors TPA’s file resolution plans
• Represents Amergis in depositions, mediation, and conference calls regarding assigned claim files
• Provides analysis on the financial aspects of assigned claims files
• Provides excellent customer service to injured workers
• Prepares WC claim reports for department management team
• Reviews, identifies and makes recommendations for maintaining control and/or reducing the claims experience (loss history) of the company
• Authorizes or revise reserve requests
• Coordinates with Benefits team during employee’s absence
• Coordinates with state programs and internal departments for transitional duty
• Educates branch offices about all aspects of Workers’ Compensation
• Assists Manager in achieving overall department goals
• Performs other duties as assigned/necessary

Minimum Requirements

• College degree preferred; or equivalent work experience
• 5 to 10 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 is required

Benefits

At Amergis Healthcare Staffing, we firmly believe that our employees are the heartbeat of our organization and we are happy to offer the following benefits: Medical/Prescription, Dental, Vision, Health Advocacy (company paid if enrolled Medical), Health Advocate Employee Assistance Program, Health Savings Account , 401(k), 401(k) Company Match, Profit Sharing, Short Term Disability, Long Term Disability, Primary Caregiver Leave, Parental Leave, Life and Basic Accidental Death and Dismemberment Insurance, Voluntary Life and Accidental Death and Dismemberment Insurance, Hospital Expense Protection Plan, Critical Illness Insurance, Accident Insurance, Dependent Care Flexible Spending Account, Home and Auto Insurance, Pet Insurance, MilkStork, Transportation Benefit, Educational Assistance Program, College Partnership Program, Paid Time Off/Company Holidays

• Benefit eligibility is dependent on employment status.

Amergis Healthcare Staffing 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.

This posting will remain active on job boards for 5 days from date of posting unless there is a good faith basis to extend the posting date.

Please note that this pay range represents a good faith estimate of the compensation that will be offered for this position based on the circumstances. The actual pay offered to a successful candidate will take into account a wide range of factors, including but not limited to location, experience, and other variable factors.

Pursuant to the San Francisco Fair Chance Initiative, Amergis will consider for employment qualified applicants with arrest and conviction records