Bilingual Senior Claims Examiner - Remote or Hybrid

Athens Administrators • Orange, CA

10d • Hybrid

About The Position

Athens Administrators is hiring a full-time Bilingual Senior Claims Examiner in California to support its workers’ compensation offices. Employees who live less than 26 miles from the Concord, CA, or Orange, CA, offices must work in the office once a week on a supervisor-designated day between Tuesday and Thursday. The remaining days may be worked remotely if technical requirements are met and the employee resides in California. Athens offices are open Monday through Friday, 7:30 a.m. to 5:30 p.m. local time. This position works 37.5 hours per week, Monday through Friday, with an option for a flexible schedule.

The Senior Claims Examiner adjusts workers’ compensation claims from inception through settlement and closure. The role ensures timely claim processing and benefit payments, manages and directs medical treatment, sets reserves, negotiates settlements, and uses fluent Spanish skills with claimants on the account. The position also provides direction and support to Claims Assistants and Claims Technicians, including training, coaching, and mentoring as needed.

Athens Administrators describes itself as a family-owned claims administration company founded in 1976, with operations in Workers’ Compensation, Property & Casualty, Program Business, and Managed Care. It promotes a supportive and inclusive culture and opportunities for professional growth. The position is non-exempt, is in job grade 12, and has a career progression that may include Lead Senior Claims Examiner or Claims Supervisor. The company provides equal employment opportunities and states that honesty, integrity, service, results, and a caring family culture are core values.

Requirements

• Fluency in Spanish is required.
• High school diploma or equivalent (GED) is required.
• 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), is required.
• At least 3 years of recent workers’ compensation claims handling experience is required.
• Solid knowledge of workers’ compensation laws, policies, and procedures.
• Completion of IEA or equivalent courses.
• Proficiency in determining case value and negotiating settlements.
• Understanding of medical and legal terminology.
• Mathematical calculation skills.
• 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 making appropriate recommendations and resolutions.
• Ability to be trustworthy, dependable, and team-oriented; demonstrate care and concern for team members and clients; and act with integrity, including when handling confidential, proprietary, and sensitive information.
• Ability to reliably commute to meetings and events as required by the position.
• If not already obtained, an Administrators Certificate from Self-Insurance Plans is required within one year of employment.

Nice To Haves

• An AA/AS or BA/BS degree is preferred but not required.
• At least 5 years of workers’ compensation claims experience is preferred.

Responsibilities

• Establish contact with employers to review claim issues and respond to inquiries from employers, employees, doctors, and attorneys.
• Establish and maintain appropriate reserves.
• Review legal correspondence and medical reports.
• Evaluate and approve medical procedures and treatment; discuss treatment appropriateness with medical case managers.
• Administer benefits and ensure payments are appropriate.
• Investigate coverage, liability, and the monetary value of claims; determine compensability.
• Review medical and legal bills for appropriateness.
• Monitor and assist with litigation, including collaborating with attorneys on settlements and litigation strategies.
• Negotiate claim settlements, liens, rehabilitation plans, and the cost of medical treatment and supplies.
• Prepare and present reports to clients and prepare professional written correspondence and other communications.
• Appropriately close claims.
• Help resolve client billing and payment inquiries and investigate complaints from injured workers.
• Document and code claim files and claims systems with 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.
• Communicate with employers, employees, attorneys, doctors, vendors, other parties, and internal staff.
• Provide customer service and support to clients and claimants.
• Use fluent Spanish skills with claimants on the account.

Benefits

• Medical, vision, dental, life and AD&D, long-term care, critical care, accidental, and hospital indemnity plans.
• HSA and FSA options.
• 401(k) and Roth 401(k).
• Company-paid short-term and long-term disability insurance.
• Eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED