Remote Senior Workers' Comp Claims Examiner

Athens Administrators, Inc.; Concord (CA); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Athens Administrators is seeking a Senior Claims Examiner to support our California workers’ compensation operations. The role involves managing claims from inception through settlement, adjusting reserves, and directing medical treatment while ensuring timely processing and accurate payments.

Located anywhere in California, with in-office attendance required for certain offices within 26 miles of Concord or Orange.

Qualifications

• 3+ years recent workers' compensation claims handling required
• At least 5 years workers' compensation claims experience preferred
• Solid knowledge of workers' compensation laws, policies, and procedures
• Completion of IEA or equivalent courses
• Proficiency in determining case value and negotiating settlements
• Understanding of medical and legal terminology
• Mathematical calculating skills
• Well-developed verbal and written communication skills with strong attention to detail
• Excellent organizational skills and ability to multi-task
• Ability to type quickly and accurately
• Proficiency in Microsoft Office Suite

Responsibilities

• Establish contact with employer to review issues
• Respond to inquiries from the employer, employee, doctors, and attorneys
• Establish and maintain appropriate reserves
• Review legal correspondence and medical 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 appropriateness of medical treatment with medical case manager
• Determine compensability
• Monitor and assist litigation
• Negotiate settlement of claim, liens, rehabilitation plans, etc.

Skills

Verbal communication

Written communication

Organizational skills

Multitasking

Typing

MS Office

Analytical skills

Problem solving

Team player

Integrity

Confidentiality

Education

High School Diploma or GED

AA/AS or BA/BS preferred

Administrators Certificate

IEA or equivalent courses

Experienced Indemnity Claims Adjuster Designation

Tools

MS Office Suite

Job description

Athens Administrators is seeking a Senior Claims Examiner to support our California workers’ compensation operations. The role involves managing claims from inception through settlement, adjusting reserves, and directing medical treatment while ensuring timely processing and accurate payments.

Located anywhere in California, with in-office attendance required for certain offices within 26 miles of Concord or Orange.