Bilingual Senior Claims Examiner - Remote or Hybrid
• Full job description found on careers page: https://www.athensadmin.com/careers/job-openings/ Career Ladder: Next step in progression could include Lead Senior Claims Examiner or Claims Supervisor POSITION SUMMARY Athens Administrators has an immediate need for a full-time Bilingual Senior Claims Examiner to support our workers compensation offices and can be located anywhere in Southern California, however, employees who live less than 26 miles from the 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 Southern 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 Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing and directing medical treatment, setting reserves, and negotiating settlements. They will use fluent Spanish skills with claimants on the account. PRIMARY RESPONSIBILITIES Our 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:
- Establish contact with employer to review issues
- Respond to inquiries from the employer, employee, doctors, and attorneys
- Establish and maintain appropriate reserves
- Review legal correspondence and medical reports
- Evaluate and approve medical procedures and treatment
- Administer benefits and ensure appropriateness of all payments
- Investigate coverage, liability and monetary value of claim
- Review medical and legal bills for appropriateness
- Discuss appropriateness of medical treatment with medical case manager
- Determine compensability
- Monitor and assist litigation
- Negotiate settlement of claim, liens, rehabilitation plans, etc.
- Prepare and present reports to clients
- Appropriately close claims
- 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 direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasks
- Contact with employers, employees, attorneys, doctors, vendors and other parties
- Provide customer service and support to clients and claimants
- Work collaboratively with attorneys to draft settlements and assist with litigation strategies
- Negotiate settlements
- Authorize and negotiate cost of medical treatment and supplies
- Internal communication with staff
- Prepare professional, well written correspondence and other communications
ESSENTIAL POSITION REQUIREMENTS 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.
- Fluency in Spanish required
- 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
- 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)
- 3+ years recent workers compensation claims handling experience required
- At least 5 years of workers compensation claims experience preferred
- 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 calculating skills
APPLY WITH US We look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. 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 Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf THANK YOU! We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don’t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages! Apply tot his job Apply To this Job