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Athens Administrators · 1 day ago

Senior Claims Examiner

California, United States

Full-time

Hybrid

Mid, Senior Level

3+ years exp

Athens Administrators is a dynamic leader in claims administration, fostering a supportive and inclusive culture. They are seeking a full-time Senior Claims Examiner to manage workers' compensation claims from inception through settlement, ensuring timely processing and payment of benefits while collaborating with various stakeholders.

ComplianceFinancial ServicesInsuranceProperty Insurance

Growth Opportunities

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

Determine compensability

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

Qualification

Workers Compensation ClaimsClaims Adjuster DesignationNegotiating SettlementsMedicalLegal TerminologyMicrosoft Office SuiteMathematical Calculating SkillsVerbal Communication SkillsWritten Communication SkillsOrganizational SkillsProblem-Solving SkillsTeam-Oriented

Required

High School Diploma or equivalent (GED) required for all positions

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

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

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

Must be able to reliably commute to meetings and events as required by this position