Claims Examiner Workers Comp

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