Assistant Claims Examiner - Flex

Athens Administrators•Concord, CA

20d•Hybrid

About The Position

Athens Administrators is hiring an experienced Assistant Claims Examiner to support its Workers’ Compensation department. The role may be based anywhere in California. Employees living within 26 miles of the Concord, California, or Orange, California, offices must work in the office once weekly on a supervisor-selected day between Tuesday and Thursday; other workdays may be remote if technical requirements are met and the employee lives in California. The position provides clerical and technical support to Senior Claims Examiners and administers Medical Only claims. It helps ensure timely claim processing and benefit payments, coordinates and directs medical treatment, and sets reserves for a variety of teams and clients. The schedule is Monday through Friday, 37.5 hours per week, with the option of a flex schedule. Athens offices are open Monday through Friday from 7:30 a.m. to 5:30 p.m. local time. The position is non-exempt, Job Grade 6, and reports to a Claims Supervisor. A possible next step in the career ladder could include Future Medical Examiner or Claims Examiner Trainee.

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.
Excellent 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 solutions.
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

Associate of Arts/Associate of Science or Bachelor of Arts/Bachelor of Science degree.
Two or more years of Claims Assistant experience supporting a workers’ compensation examiner or team.
Medical Only Adjuster designation is strongly preferred (and 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, process approved provider bills, and prepare objections to provider bills when needed.
Respond to medical providers’ questions about bills and contact treating physicians about disability status.
Contact employers about return-to-work status or modified-work availability, and contact injured workers during initial claim setup.
Send DWC and SJDB notices on time and request job descriptions and other required claim documents from employers.
Handle Medical Only claim files; calculate wage statements and adjust disability rates as required.
Maintain claim diaries, document file activity, and update claim information in computer systems.
Schedule AME and QME evaluations; send appointment letters; issue temporary disability and mileage payments; send medical files; and arrange interpreters for appointments and depositions.
Request employer reports, DWC-1 forms, and doctors’ first reports when needed; verify mileage and treatment dates for claimant reimbursement; and subpoena records.
File and serve documents on attorneys, WCAB, and doctors; serve treating physicians with medical files and Duties of Treating Physician forms; and request permanent disability ratings from DEU.
Draft stipulated awards and compromise and release agreements, and submit them to WCAB for approval with documentation.
Process check stop payments, cancellations, voids, and journal payments.
Complete penalty calculations and worksheets; complete MPN, HCO, and/or EDI coding; make investigator referrals; and prepare documents for overnight delivery.
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 claim-status updates to Senior Claims Examiners and Athens management, and prepare professional written correspondence and other communications.
Reliably commute to meetings and events required by the position.

Benefits

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