Senior Claims Examiner — Remote/Hybrid CA

Athens Administrators, Inc.; San Francisco (CA); Hybride; USD 85 000 - 120 000; Plein temps

Résumé du poste

Athens Administrators is seeking a Senior Claims Examiner to support California workers’ compensation claims. This full-time role can be performed remotely within California or in a hybrid arrangement, with some in-office days from Concord or Orange offices as required by the supervisor.

Responsibilities include handling claims from inception to settlement, establishing reserves, directing medical treatment, and negotiating settlements.

Qualifications

• 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 required within one year of employment.
• Current Experienced Indemnity Claims Adjuster designation, as defined by CA regulations.

Responsabilités

• 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 payment accuracy.
• Investigate coverage, liability, and value of claims.
• Review medical/legal bills for appropriateness.
• Discuss treatment with medical case manager.
• Monitor and assist litigation as needed.
• Negotiate settlements and liens.
• Prepare and present client reports.
• Close claims appropriately.
• Assist with training and mentoring staff.
• Communicate with employers, employees, attorneys, and vendors.

Connaissances

Workers' compensation knowledge

Claims handling

Negotiation skills

Communication skills

Regulatory compliance

Formation

High School Diploma or equivalent

AA/AS or BA/BS preferred

Administrators Certificate (within 1 year)

Experienced Indemnity Claims Adjuster designation

Outils

Microsoft Office Suite

Description du poste

Athens Administrators is seeking a Senior Claims Examiner to support California workers’ compensation claims. This full-time role can be performed remotely within California or in a hybrid arrangement, with some in-office days from Concord or Orange offices as required by the supervisor.

Responsibilities include handling claims from inception to settlement, establishing reserves, directing medical treatment, and negotiating settlements.