Senior Claims Examiner - Flex

Athens Administrators • Concord, CA

21d • Hybrid

About The Position

Athens Administrators is hiring a full-time Senior Claims Examiner to support its California workers’ compensation offices. The position may be based remotely or in a hybrid arrangement anywhere in California, subject to technical requirements. Employees who live within 26 miles of the Concord or Orange, California offices must work in the office once a week on a supervisor-determined day between Tuesday and Thursday; other workdays may be remote. The schedule is Monday through Friday, 37.5 hours per week, with a flex-schedule option. The offices are open Monday through Friday, 7:30 a.m. to 5:30 p.m. local time.

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; establishes reserves; and negotiates settlements. The examiner supports a variety of teams and clients across different industries, providing exposure to a range of workers’ compensation work. The position also provides direction and, as needed, training, coaching, and mentoring to Claims Assistants and Claims Technicians.

Athens Administrators describes itself as a family-owned claims administration company founded in 1976, serving workers’ compensation, property and casualty, program business, and managed care. It emphasizes a supportive, inclusive culture and opportunities for professional growth. The role requires a high school diploma or GED, a current Experienced Indemnity Claims Adjuster Designation as defined by California regulations, and at least three years of recent workers’ compensation claims-handling experience. An Administrators Certificate from Self-Insurance Plans must be obtained within one year if the employee does not already hold one.

Requirements

• High school diploma or equivalent (GED).
• 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).
• At least 3 years of recent workers’ compensation claims-handling experience.
• Administrators Certificate from Self-Insurance Plans, if not already obtained, within one year of employment.
• 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, with 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 making appropriate recommendations and solutions.
• Trustworthiness, dependability, and a team-oriented approach.
• Ability to seek innovative strategies and methods to provide a high level of service and results.
• Ability to demonstrate care and concern for team members and clients in a professional, friendly manner and act with integrity in challenging situations.
• Ability to reliably commute to meetings and events required by the position.

Nice To Haves

• AA/AS or BA/BS degree.
• At least 5 years of workers’ compensation claims experience.

Responsibilities

• Establish contact with employers to review claim issues and respond to inquiries from employers, employees, doctors, and attorneys.
• Establish and maintain appropriate claim reserves.
• Review legal correspondence and medical reports; evaluate and approve medical procedures and treatment.
• 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 and discuss treatment appropriateness with medical case managers.
• Monitor and assist with litigation, including working with attorneys on settlements and litigation strategies.
• Negotiate settlements, liens, rehabilitation plans, medical treatment, and supplies.
• Prepare and present reports to clients and prepare professional written correspondence and other communications.
• Close claims appropriately and help resolve client billing and payment inquiries.
• Investigate complaints from injured workers.
• Document and code claim files and claims systems with relevant information, and maintain and update action plans within required time frames.
• Provide direction to Claims Assistants and Claims Technicians and assist with their training, coaching, and mentoring as needed.
• Communicate with employers, employees, attorneys, doctors, vendors, and other parties; provide customer service and support to clients and claimants.
• Collaborate with attorneys on settlement drafts and litigation strategies.

Benefits

• Medical, vision, and dental plans.
• Life and AD&D insurance.
• Long-term care, critical care, accident, and hospital indemnity coverage.
• HSA and FSA options.
• 401(k) and Roth options.
• 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