Bilingual Senior Claims Examiner — Remote/Hybrid (CA)

Athens Administrators, Inc.; Orange (CA); Hybrid; USD 75,000 - 105,000; Full time

Job summary

Athens Administrators, Inc. is seeking a full-time Bilingual Senior Claims Examiner to support its California workers' compensation offices.

The role allows Remote or Hybrid work; in-office presence is required for some CA locations if within 26 miles of Concord or Orange. Typical schedule is Monday–Friday, 37.5 hours with potential flex; responsibilities include managing claims from inception to closure, reserving, medical treatment management, settlements, and collaboration with attorneys and

Qualifications

• Fluency in Spanish required
• High School Diploma or equivalent (GED) required for all positions; AA/AS or BA/BS preferred but not required
• Administrators Certificate from Self-Insurance Plans must be obtained within one year of employment
• Current Experienced Indemnity Claims Adjuster Designation required by CA standards
• 3+ years recent workers' compensation claims handling experience required
• At least 5 years of workers' compensation claims experience preferred
• Solid knowledge of workers' compensation laws, policies and procedures
• Proficiency in Microsoft Office Suite
• Strong typing and data entry skills

Responsibilities

• Establish contact with employer to review issues
• Respond to inquiries from employer, employee, doctors, and attorneys
• Establish and maintain appropriate reserves
• Review medical and legal reports
• Evaluate and approve medical procedures and treatment
• Administer benefits and ensure appropriateness of all payments
• Investigate coverage, liability and monetary value of claim
• Review medical and legal bills for appropriateness
• Discuss medical treatment with medical case manager
• Monitor and assist litigation
• Negotiate settlements
• Prepare and present reports to clients
• Provide customer service and support to clients and claimants
• Work with attorneys to draft settlements and assist with litigation strategies
• Coordinate with Claims Assistants and Menticians as needed

Skills

Fluency in Spanish

Attention to detail

Verbal and written communication

Education

High School Diploma or equivalent (GED)

AA/AS or BA/BS preferred but not required

Administrators Certificate

Tools

Microsoft Office Suite

Job description

Athens Administrators, Inc. is seeking a full-time Bilingual Senior Claims Examiner to support its California workers' compensation offices.

The role allows Remote or Hybrid work; in-office presence is required for some CA locations if within 26 miles of Concord or Orange. Typical schedule is Monday–Friday, 37.5 hours with potential flex; responsibilities include managing claims from inception to closure, reserving, medical treatment management, settlements, and collaboration with attorneys and