Assistant Claims Examiner - Multi-Client

Athens Administrators•Los Angeles, CA

9d•Hybrid

About The Position

Athens Administrators is hiring an experienced Assistant Claims Examiner to support its Workers’ Compensation department. The position provides clerical and technical assistance to Senior Claims Examiners and administers Medical Only claims, helping ensure timely claim processing and benefit payments, directing medical treatment, and setting reserves across a variety of teams and clients. The role may be performed from anywhere in California. Employees residing less than 26 miles from the Concord, CA, or Orange, CA, offices must work in the office once a week on a supervisor-assigned day between Tuesday and Thursday; the remaining workdays may be remote if technical requirements are met. The schedule is Monday through Friday, 37.5 hours per week, with an option for a flexible schedule. Athens offices are open Monday through Friday, 7:30 a.m. to 5:30 p.m. local time. The role involves processing claims and payments, coordinating medical treatment and evaluations, maintaining claim files, preparing correspondence and legal or claims documents, communicating with claimants and other parties, and supporting claims examiners and management. The position requires a high school diploma or equivalent, and the Medical Only Adjuster designation must be obtained after hire. An associate or bachelor’s degree is preferred but not required.

Requirements

High school diploma or equivalent (GED).
Medical Only Adjuster designation required after hire; continuing hours must be current.
Mathematical calculation skills.
Completion of IEA or equivalent courses.
Knowledge of workers’ compensation laws, policies, and procedures.
Understanding of medical and legal terminology.
Accuracy and thoroughness in work product.
Ability to sit for prolonged periods.
Well-developed verbal and written communication skills and strong attention to detail.
Strong organizational skills and ability to multitask.
Ability to type quickly and accurately for prolonged periods.
Proficiency in Microsoft Office Suite and ability to learn additional computer programs.
Reasoning, problem-solving, and analytical skills, including researching and analyzing facts, identifying issues, and recommending appropriate resolutions.
Trustworthiness, dependability, and a team-oriented approach; ability to act with integrity and demonstrate care and concern for colleagues and clients.
Ability to reliably commute to meetings and events as required.

Nice To Haves

AA/AS or BA/BS degree.
Two or more years of Claims Assistant experience supporting a workers’ compensation examiner or team.
Medical Only Adjuster designation (strongly preferred; required after hire).
Administrators Certificate from Self-Insurance Plans.

Responsibilities

Process new claims in compliance with client service agreements.
Issue indemnity payments and awards on time and process approved provider bills promptly.
Prepare objection letters to providers regarding delayed, denied, or inadequately documented medical bills.
Answer medical providers’ questions about bills and contact treating physicians regarding disability status.
Contact employers about return-to-work status or modified-work availability and contact injured workers during initial claim setup.
Send DWC notices and SJDB notices on time; request job descriptions from employers.
Handle Medical Only claim files, calculate wage statements, and adjust disability rates as required.
Maintain diaries for delay dates and indemnity payments; document claim activity and update information in computer systems.
Schedule AME and QME evaluations; send appointment letters; issue temporary disability and mileage payments; and arrange medical files and interpreters for appointments or depositions.
Request employer reports, DWC-1 forms, and doctors’ first reports as needed.
Verify mileage and treatment dates for claimant reimbursement and subpoena records.
File and serve documents on attorneys, the WCAB, and doctors; serve primary treating physicians with medical files and Duties of Treating Physician forms.
Request permanent disability ratings from the DEU; draft stipulated awards and compromise and release agreements; and submit awards and agreements to the WCAB for approval with documentation.
Process check stop payments, cancellations, voids, and journal payments.
Complete penalty calculations and prepare penalty worksheets; complete MPN, HCO, and/or EDI coding; and make referrals to investigators.
Prepare documents for overnight delivery and handle telephone calls for examiners as needed.
Collaborate with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners.
Communicate with clients, injured workers, attorneys, doctors, vendors, and other parties; provide claims status updates to Senior Claims Examiners and Athens management.
Prepare professional, well-written correspondence and other communications.

Benefits

Medical insurance
Vision insurance
Dental insurance
Life insurance
AD&D insurance
Long-term care insurance
Critical care insurance
Accidental insurance
Hospital indemnity insurance
HSA and FSA options
401(k) and Roth 401(k)
Company-paid short-term disability and long-term disability
Eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments