Senior Workers’ Comp Claims Examiner — Remote

Athens Administrators, Inc.; California (MD); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Medical Insurance

Vision Insurance

Dental Insurance

Life Insurance

AD&D

Long Term Care

401k

Job summary

Athens Administrators seeks a Senior Claims Examiner to support California workers’ compensation claims from inception through settlement. You will adjust reserves, manage medical treatment, negotiate settlements, and work with attorneys to protect client interests.

This full-time role allows remote work with occasional in-office days for CA residents near Concord or Orange, and includes a robust benefits package (medical, vision, dental, life/AD&D, LTD, 401k) and opportunities for career

Qualifications

• Must have 3+ years recent workers compensation claims handling experience
• At least 5 years of workers compensation claims experience preferred
• Solid knowledge of workers compensation laws, policies, and procedures
• Proficiency in determining case value and negotiating settlements
• Understanding of medical and legal terminology
• Mathematical calculating skills

Responsibilities

• Establish contact with employer to review issues
• Respond to inquiries from employer, employee, doctors, and attorneys
• Establish and maintain reserves
• Review medical and legal 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
• Determine compensability
• Monitor and assist litigation
• Negotiate settlement of claim, liens, rehabilitation plans, etc.

Skills

Strong communication

Attention to detail

Negotiation

Medical terminology

Analytical skills

Team collaboration

Integrity

Education

High School Diploma or GED

AA/AS or BA/BS preferred

Administrators Certificate within 1 year

Experienced Indemnity Claims Adjuster Designation

IEA or equivalent courses

Job description

Athens Administrators seeks a Senior Claims Examiner to support California workers’ compensation claims from inception through settlement. You will adjust reserves, manage medical treatment, negotiate settlements, and work with attorneys to protect client interests.

This full-time role allows remote work with occasional in-office days for CA residents near Concord or Orange, and includes a robust benefits package (medical, vision, dental, life/AD&D, LTD, 401k) and opportunities for career