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Role Description

Athens Administrators has an immediate need for an experienced Assistant Claims Examiner to support our Workers’ Compensation department and can be located anywhere in the state of California. 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. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule.

• Provide clerical and technical assistance to Senior Claims Examiners
• Administer Medical Only claims, ensuring timely processing of claims and payment of benefits
• Manage and direct medical treatment, and set reserves
• Use fluent Spanish skills with claimants on the account

Primary Responsibilities

• Process new claims in compliance with client’s Service Agreement
• Issue all indemnity payments and awards on time
• Process all approved provider bills timely
• Prepare objection letters to providers for medical bills; delayed, denied, lacking reports
• Answer questions over the phone from medical providers regarding bills
• Contact treating physician for disability status
• Contact employer for return-to-work status or availability of modified work
• Contact injured worker at initial set up
• Send DWC notices timely
• Issue SJDB Notices timely
• Request Job Description from Employer
• Handle Medical Only claim files
• Calculate wage statements and adjust disability rates as required
• Keep diary for all delay dates and indemnity payments
• Document file activity on computer
• Update information on computer, i.e., address changes, etc.
• Schedule appointments for AME, QME evaluations
• Send appointment letters, issue TD/mileage, send medical file
• Schedule interpreter for appointments, depositions, etc.
• Request Employer’s Report, DWC-1, Doctor’s First Report if needed
• Verify mileage and dates of treatment for reimbursement to claimant
• Subpoena records
• File and serve documents on attorneys, WCAB, doctors
• Serve PTP’s with medical file and Duties of Treating Physician (9785)
• Request PD ratings from DEU
• Draft Stipulated Awards and C&R’s
• Submit C&R, Stipulated Awards to WCAB for approval with documentation
• Process checks – stop payment, cancellations, void, journal payments
• Handle telephone calls for examiner as needed
• Complete penalty calculations and prepare penalty worksheets
• Complete MPN, HCO and/or EDI coding
• Complete referrals to investigators
• Complete preparation of documents for overnight delivery
• Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners
• Contact with clients, injured workers, attorneys, doctors, vendors, and other parties
• Provide updates of claims status to Senior Claims Examiners and Athens management
• Prepare professional, well written correspondence and other communications

Essential Position Requirements

• High School Diploma or equivalent (GED) required for all positions
• AA/AS or BA/BS preferred but not required
• 2+ years’ Claims Assistant experience supporting a workers compensation examiner or team preferred
• Medical Only Adjuster designation required
• Fluency in Spanish required
• Continuing hours must be current
• Mathematical calculating skills
• Completion of IEA or equivalent courses
• Administrators Certificate from Self-Insurance Plans preferred
• Knowledge of workers compensation laws, policies, and procedures
• Understanding of medical and legal terminology
• Must demonstrate accuracy and thoroughness in work product
• Ability to sit for prolonged periods of time
• 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
• 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

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.