Assistant Claims Examiner

ATHENS ADMINISTRATORS; California (MO); Hybrid; USD 40,000 - 70,000; Full time

Job summary

An established industry player is seeking an experienced Assistant Claims Examiner to enhance their Workers' Compensation team. This role offers a blend of in-office and remote work within California, providing the flexibility to balance personal and professional commitments. The ideal candidate will support Senior Claims Examiners by processing claims, managing medical treatments, and ensuring timely payments. This position is perfect for those who thrive in a collaborative environment and are dedicated to delivering exceptional service. Join a company that values integrity, teamwork, and professional growth, making a significant impact in the lives of injured workers.

Benefits

Medical Insurance

Vision Insurance

Dental Insurance

401k Plan

Flexible Schedule

Company-Paid STD & LTD

Life Insurance

Critical Care Insurance

Accidental Insurance

Hospital Indemnity Insurance

Qualifications

• 2+ years’ experience as a Claims Assistant in workers' compensation preferred.
• Medical Only Adjuster designation required with current continuing hours.

Responsibilities

• Process new claims and issue payments in compliance with service agreements.
• Provide clerical support to Senior Claims Examiners and manage medical claims.

Skills

Claims Processing

Mathematical Skills

Communication Skills

Organizational Skills

Problem-Solving Skills

Education

High School Diploma or equivalent

AA/AS or BA/BS

Tools

Microsoft Office Suite

Job description

We’re always looking for exceptional professionals to join our team. Take a look at the positions currently available and consider if one might be right for you.

Location: California, CA

Job Id: 1267

# of Openings: 1

ATHENS POSITION DETAILS

Position Title: Assistant Claims Examiner

Department: Workers’ Compensation

Reports To: Senior Claims Examiners

FLSA Status: Non-Exempt

Job Grade: 6

Next step in progression could include Future Medical Examiner or Claims Examiner Trainee.

POSITION SUMMARY

Athens Administrators has an immediate need for an experienced Assistant Claims Examiner to support our Workers’ Compensation department. This position can be located anywhere in the state of California; however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday – Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Assistant Claims Examiner will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves.

PRIMARY RESPONSIBILITIES

Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:

• Process new claims in compliance with client’s Service Agreement
• Issue all indemnity payments and awards on time
• Process all approved provider bills timely
• Prepare objection letters to providers for medical bills; delayed, denied, lacking reports.
• Answer questions over the phone from medical providers regarding bills
• Contact treating physician for disability status
• Contact employer for return-to-work status or availability of modified work.
• Contact injured worker at initial set up
• Send DWC notices timely
• Issue SJDB Notices timely
• Request Job Description from Employer
• Handle Medical Only claim files
• Calculate wage statements and adjust disability rates as required
• Keep diary for all delay dates and indemnity payments
• Document file activity on computer
• Update information on computer, i.e., address changes, etc.
• Schedule appointments for AME, QME evaluations
• Send appointment letters, issue TD/mileage, send medical file
• Request Employer’s Report, DWC-1, Doctor’s First Report if needed
• Verify mileage and dates of treatment for reimbursement to claimant
• Subpoena records
• File and serve documents on attorneys, WCAB, doctors
• Serve PTP’s with medical file and Duties of Treating Physician (9785)
• Request PD ratings from DEU
• Draft Stipulated Awards and C&R’s
• Submit C&R, Stipulated Awards to WCAB for approval with documentation
• Process checks – stop payment, cancellations, void, journal payments
• Handle telephone calls for examiner as needed
• Complete penalty calculations and prepare penalty worksheets
• Complete MPN, HCO and/or EDI coding
• Complete referrals to investigators
• Complete preparation of documents for overnight delivery
• Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners
• Contact with clients, injured workers, attorneys, doctors, vendors, and other parties
• Provide updates of claims status to Senior Claims Examiners and Athens management
• Prepare professional, well written correspondence and other communications

ESSENTIAL POSITION REQUIREMENTS

The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.

• High School Diploma or equivalent (GED) required for all positions
  • AA/AS or BA/BS preferred but not required
• 2+ years’ Claims Assistant experience supporting a workers compensation examiner or team preferred
• Medical Only Adjuster designation required
• Continuing hours must be current
• Mathematical calculating skills
• Completion of IEA or equivalent courses
• Administrators Certificate from Self-Insurance Plans preferred
• Knowledge of workers compensation laws, policies, and procedures
• Understanding of medical and legal terminology
• Must demonstrate accuracy and thoroughness in work product
• Ability to sit for prolonged periods of time
• Well-developed verbal and written communication skills with strong attention to detail
• Excellent organizational skills and ability to multi-task
• Ability to type quickly, accurately and for prolonged periods
• Proficient in Microsoft Office Suite
• Ability to learn additional computer programs
• Reasoning ability, including problem-solving and analytical skills, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
• Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
• Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
• Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner
• Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
• Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.

APPLY WITH US

We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. Please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings. Feel free to include a cover letter if you’d like to share any other details. All applications received are reviewed by our in-house Corporate Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf.

This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.

Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.

THANK YOU!

We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don’t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!

Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://www.athensadmin.com/careers/why-work-here.