Assistant Claims Examiner

About the role

Athens Administrators has an immediate need for an experienced Assistant Claims Examiner to support our Workers’ Compensation department. The position can be located anywhere in California, but 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.

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
• 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
• 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)
• 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
• Prepare professional, well written correspondence and other communications

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
• 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
• Able 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
• Able 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
• Seeking to include innovative strategies and methods to provide a high level of commitment to service and results
• Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor

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!