Senior Claims Examiner - Flex

Athens Administrators, Inc.; Concord (CA); Hybrid; USD 70,000 - 110,000; Full time

Benefits offered by this job

Medical benefits

401k plan

Job summary

Athens Administrators has an immediate need for a full-time Senior Claims Examiner - Flex to support our workers' compensation offices. This role can be located anywhere in California, with weekly in-office days required for those within 26 miles of the Concord, CA or Orange, CA offices, on a day determined by their supervisor.

The remaining days can be worked remotely if technical requirements are met, and the employee resides in California.

Qualifications

• High School Diploma or GED required; AA/AS or BA/BS preferred.
• Must possess a current Experienced Indemnity Claims Adjuster designation issued by an insurer (CA Code).
• 3+ years recent workers' compensation claims handling experience.
• At least 5 years of workers' compensation claims experience preferred.
• Solid knowledge of workers' comp laws, policies, and procedures.
• Proficiency in Microsoft Office Suite; ability to learn additional programs.
• Strong verbal and written 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
• Negotiate settlements
• Prepare reports to clients
• Close claims and support litigation

Skills

WC claims handling

Negotiation

Communication skills

Microsoft Office

Attention to detail

Legal terminology

Education

High School Diploma

AA/AS or BA/BS preferred

Experienced Indemnity Claims Adjuster designation

Tools

Microsoft Office Suite

Job description

Senior Claims Examiner - Flex. Remote or Hybrid in California

Department:

Reports To:

FLSA Status:

Non-Exempt

Job Grade:

12

Next step in progression could include Lead Senior Claims Examiner or Claims Supervisor

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 - Flex 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 - Flex is integral to Athens as they 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 for a variety of teams and clients at Athens. They will get to support different clients in different industries, broadening their WC exposure.

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:

• 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
• 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
• 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 analyse 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 in the company.
• Must be able to reliably commute to meetings and events as required by this position

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/ 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.

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