Senior Claims Examiner

Athens Administrators, Inc.; Concord (CA); Hybrid; USD 80,000 - 110,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental insurance

Life and AD&D insurance

401k

Paid time off

Job summary

Athens Administrators, Inc. is seeking a Senior Claims Examiner to support our California workers' compensation offices. This full-time role allows remote work with weekly in-office days for CA residents within 26 miles of Concord or Orange, on a supervisor-defined day.

The position handles claims from inception through settlement, with reserves, medical management, and settlements. Applicants should have 3+ years WC claims handling, 5+ years preferred, and hold an Experienced Indemnity Claims

Qualifications

• 3+ years recent workers' compensation claims handling experience required.
• At least 5 years workers' compensation claims experience preferred.
• Current Experienced Indemnity Claims Adjuster Designation.
• Administrators Certificate from Self-Insurance Plans within one year.
• Solid knowledge of workers' compensation laws, policies and procedures.
• Strong written and verbal communication skills and attention to detail.

Responsibilities

• Establish contact with employer to review issues and review medical/billing information.
• Adjust claims from inception through settlement; set reserves and direct medical treatment.
• Negotiate settlements and monitor litigation as needed.
• Prepare client reports and maintain accurate claim documentation.
• Provide training and guidance to junior staff and coordinate with attorneys and medical providers.

Skills

Verbal communication

Written communication

Attention to detail

Team collaboration

Time management

Education

AA/AS or BA/BS preferred

Administrators Certificate from Self-Insurance Plans

IEA or equivalent courses

Tools

Microsoft Office Suite

Job description

Location:

Concord, CA

Job Id:

1641

# of Openings:

1

ATHENS POSITION DETAILS

Position Title:

Department:

Reports To:

FLSA Status:

Non-Exempt

Job Grade:

12

ATHENS ADMINISTRATORS

Explore the Athens Administrators difference: We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today!

POSITION SUMMARY

Athens Administrators has an immediate need for a full-time Senior Claims Examiner to support our workers compensation offices and 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 Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements. The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, setting reserves, and negotiating settlements.

PRIMARY 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
• 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
• Document and code the claim files and claims system with all relevant information
• Maintain and update action plans within specified time frames
• Provide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasks
• Contact with employers, employees, attorneys, doctors, vendors, and other parties
• Provide customer service and support to clients and claimants
• Work collaboratively with attorneys to draft settlements and assist with litigation strategies
• Negotiate settlements
• Authorize and negotiate cost of medical treatment and supplies
• Internal communication with staff
• Prepare professional, well written correspondence and other communications

ESSENTIAL POSITION REQUIREMENTS

• 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 will be required within one year of employment if not already obtained
• Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f)
• 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’
• 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, 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.
• Must be able to reliably commute to meetings and events as required by this position

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 an Equal Opportunity/ Afficiant 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.

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