Assistant Claims Examiner - Remote or Hybrid in TX

Athens Administrators•San Antonio, TX

1d•Hybrid

About The Position

Athens Administrators has an immediate need for an experienced Assistant Claims Examiner to support our Texas Workers’ Compensation department. Employees who live less than 26 miles from the San Antonio, TX office 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 Texas. 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 Assistant Claims Examiner will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves.

Requirements

High School Diploma or equivalent (GED) required for all positions
2+ years’ Claims Assistant experience supporting a workers compensation examiner or team preferred
Knowledge of worker injury laws, policies, and procedures
Texas 03 WC or Texas 8 All Lines license required within one year
Mathematical calculating skills
Administrators Certificate from Self-Insurance Plans preferred
Knowledge of workers compensation laws, policies, and procedures
Understanding of medical and legal terminology
Must demonstrate accuracy and thoroughness in work product
Ability to sit for prolonged periods of time
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
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 within the company.
Must be able to commute to meetings and events as required by this position

Nice To Haves

AA/AS or BA/BS preferred but not required

Responsibilities

Review, update claim coding and reassign new claims in compliance with client’s Service Agreement
Approve all provider bills timely for Medical Only claims assigned
Answer questions over the phone from medical providers regarding bills
Contact treating physician for disability status
Contact employer for return-to-work status or availability of modified work for medical only claims and as directed by Examiners
Request Job Description from Employer
Handle Medical Only claim files
Documents file activity on computer
Update information on computer, i.e. address changes, etc.
Schedule appointments for IME evaluations
Send appointment letters, send medical file
Schedule interpreter for appointments, depositions, etc.
Handle telephone calls for examiner as needed
Complete file closing
Complete preparation of documents for overnight delivery
Work collaboratively with Senior Claims Examiners, Nurse Case Managers and other Assistant Claims Examiners
Contact with clients, injured workers, doctors and vendors
Answer phone calls/receptionist responsibilities