Future Medical Claims Examiner

Athens Administrators • Fresno, CA

14d • Hybrid

About The Position

Athens Administrators has an immediate need for a Future Medical Examiner to support our Workers Compensation department and can be located anywhere in the state of California, however, Central Valley is the ideal location to be able to attend quarterly in person file reviews. Employees who live less than 26 miles from the Concord, CA or Orange, CA offices 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 California. 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 Future Medical Examiner will adjust workers’ compensation future medical claims, ensure timely processing of claims and payment of benefits (medical, Permanent Disability, Life Pension, and Death Benefits), managing and directing medical treatment, and negotiating settlements.

Requirements

• High School Diploma or equivalent (GED) required for all positions
• AA/AS or BA/BS preferred but not required
• Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained
• 1-2 years’ workers’ compensation claims handling experience required
• Knowledge of workers compensation claims handling procedures
• 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)
• 4850 experience preferred
• Proficiency in determining case value and negotiating settlements
• Knowledge of workers compensation laws, policies, and procedures
• Understanding of medical and legal terminology
• Mathematical calculating skills
• Negotiation skills
• Ability to carefully review records prior to sending to correct parties
• 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 reliably commute to meetings and events as required by this position

Responsibilities

• Review daily diary for claim status
• Review medical reports to determine whether additional medical opinions are needed
• Calculate and maintain appropriate reserve on each file in accordance with life expectancy
• Object to unauthorized medical treatment
• Establish contact with employer to review issues
• Respond to inquiries from the employer, employee, doctors and attorneys
• Review legal correspondence and medical reports
• Evaluate and approve medical procedures and treatment
• Administer benefits and ensure appropriateness of all payments
• Review medical and legal bills for appropriateness
• Discuss appropriateness of medical treatment with medical case manager
• Negotiate settlement of claim, liens, etc.
• Prepare and present reports to clients
• Close claims appropriately
• 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 customer service and support to clients and claimants
• Work collaboratively with attorneys
• Authorize and negotiate cost of medical treatment and supplies

Benefits

• We offer a variety of benefit plans including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more!
• Further information about our comprehensive benefits package may be found on our website at https://www.athensadmin.com/careers/why-work-here

What This Job Offers

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