Remote Senior Workers' Comp Claims Examiner

Athens Administrators; San Diego (CA); On-site; USD 85,000 - 120,000; Full time

Job summary

Athens Administrators has an immediate need for a full-time Senior Claims Examiner to support our workers' compensation offices and can be located in Southern California. The role offers remote work with in-office attendance as required for CA employees, and a 37.5-hour work week with a flex schedule.

The Senior Claims Examiner will manage claims from inception through settlement, adjust for a dedicated school district, and collaborate with legal and medical teams to optimize outcomes.

Qualifications

• Knowledge of workers' compensation laws, policies, and procedures.
• Proficiency in interpreting medical and legal terminology.
• Strong written and verbal communication with attention to detail.

Responsibilities

• Establish contact with employer to review issues.
• Respond to inquiries from 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.
• Monitor and assist litigation.
• Negotiate settlement of claim, liens, rehabilitation plans, etc.
• Prepare and present reports to clients.
• Appropriately close claims.
• Help resolve client billing and payment inquiries.
• Investigate complaints from injured workers.

Skills

Workers' compensation knowledge

Negotiation skills

Communication skills

Education

High School Diploma or equivalent

Administrators Certificate from Self-Insurance Plans (within 1 year)

CA Licensed Experienced Indemnity Claims Adjuster Designation

Tools

Microsoft Office Suite

Job description

Athens Administrators has an immediate need for a full-time Senior Claims Examiner to support our workers' compensation offices and can be located in Southern California. The role offers remote work with in-office attendance as required for CA employees, and a 37.5-hour work week with a flex schedule.

The Senior Claims Examiner will manage claims from inception through settlement, adjust for a dedicated school district, and collaborate with legal and medical teams to optimize outcomes.