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SalaryAthens Position Details
Position Title: Assistant Claims Examiner
Department: Workers’ Compensation
Reports To: Claims Supervisor
FLSA Status: Non-Exempt
Job Grade: 6
ATHENS ADMINISTRATORSSince our founding in 1976, Athens Administrators has been a recognized leader in third-party claims administration services. However, more important than what we do is how we do it. Athens employees provide service that translates into real and lasting benefits—every single day! With offices throughout the United States, Athens Administrators offers Workers’ Compensation, Property & Casualty, Managed Care and Program Business solutions. Athens is proud to be a third-generation family-owned company and is dedicated to its core values of honesty and integrity, a commitment to service and results, and a caring family culture. We are so proud that our employees have consistently voted Athens as a Best Place to Work!
POSITION SUMMARYAthens Administrators has an immediate need for an experienced Assistant Claims Examiner to support our Workers Compensation department and can be located remotely in California if technical requirements are met. Southern California residents preferred. 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. The Assistant Claims Examiner will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing and directing medical treatment, and setting reserves.
PRIMARY RESPONSIBILITIESOur new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
- Handle Medical Only claim files in compliance with client’s Service Agreement
- Issue all indemnity payments and awards with corresponding benefit notices accurately and on time
- Calculate wage statements and adjust disability rates as required
- Contact treating physician for disability status and relay status to the examiner and employer to determine the availability of modified work.
- Process all approved provider bills timely
- Prepare objection letters to providers for medical bills; delayed, denied, lacking reports
- Complete timely and detailed initial claim 3 point contacts
- Keep diary for all delay dates and indemnity payments
- Schedule appointments for AME, QME evaluations and send appointment letters, issue TD/mileage, send medical file
- Schedule interpreter for appointments, depositions, etc.
- Verify mileage and dates of treatment for reimbursement to claimant
- Subpoena records and file and serve documents on attorneys, WCAB, doctors
- Serve PTP’s with medical file and Duties of Treating Physician (9785)
- Draft Stipulated Awards and C&R’s and submit to the WCAB for approval with documentation
- Process checks – stop payment, cancellations, void, journal payments
- Other duties as assigned
The requirements listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
- High school diploma or equivalent (GED) required, college degree preferred
- 2+ years’ Claims Assistant experience supporting a Workers’ Compensation Examiner or Team preferred
- Medical Only Adjuster designation required
- Continuing hours must be current
- Completion of IEA or equivalent courses
- Administrators Certificate from Self-Insurance Plans preferred
- Experienced Indemnity Claims Adjuster Designation preferred
- Knowledge of workers compensation laws, policies and procedures
- Understanding of medical and legal terminology
- 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
- Ability to attend in-person file reviews in Orange
We look forward to learning about YOU! To be considered, please submit your resume and application directly through our website at http://www.athensadmin.com/careers/job-openings/ Feel free to include a cover letter if you’d like to share any other details. All applications received are reviewed by our in-house Corporate Recruiter.
This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.
Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.
THANK YOU!We look forward to reviewing your information. Applying for jobs isn’t necessarily fun, but we promise we are. Don’t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!
Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Additionally, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. Further information about our comprehensive benefits package may be found on our website at https://www.athensadmin.com/careers/why-work-here
