Senior Claims Examiner – Remote/Hybrid (CA)

Athens Administrators, Inc.; Sacramento (CA); Hybrid; USD 80.000 - 110.000; Vollzeit

Zusammenfassung

Athens Administrators, Inc. is seeking a Senior Claims Examiner to support our workers' compensation offices. The role can be located anywhere in California with occasional in-office days in Concord or Orange as determined by the supervisor.

The position offers a Monday–Friday schedule, with a 37.5-hour workweek and a flexible arrangement if requirements are met. The Senior Claims Examiner will manage claims from inception to settlement, establish reserves, supervise medical treatment, and

Qualifikationen

• High School Diploma or equivalent required. AA/AS or BA/BS preferred but not required.
• Administrators Certificate from Self-Insurance Plans within one year of employment.
• Current Experienced Indemnity Claims Adjuster Designation, per California regulations.
• 3+ years recent workers' compensation claims handling experience; 5+ years preferred.
• Proficiency in Microsoft Office Suite.

Aufgaben

• 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 payments are appropriate.
• Investigate coverage, liability, and value of claims.
• Review medical/legal bills for appropriateness.
• Negotiate settlements and monitor litigation as needed.
• Prepare and present reports to clients.
• Close claims and resolve client billing inquiries.
• Provide direction to junior staff and assist with training.

Kenntnisse

Strong communication

Analytical skills

Problem solving

Attention to detail

Ausbildung

High School Diploma or equivalent

AA/AS or BA/BS preferred

Administrators Certificate (Self-Insurance Plans)

Experienced Indemnity Claims Adjuster Designation (CA)

3+ years workers' compensation claims experience

5+ years workers' compensation claims experience preferred

Proficiency in Microsoft Office Suite

Tools

Microsoft Office Suite

Jobbeschreibung

Athens Administrators, Inc. is seeking a Senior Claims Examiner to support our workers' compensation offices. The role can be located anywhere in California with occasional in-office days in Concord or Orange as determined by the supervisor.

The position offers a Monday–Friday schedule, with a 37.5-hour workweek and a flexible arrangement if requirements are met. The Senior Claims Examiner will manage claims from inception to settlement, establish reserves, supervise medical treatment, and