Assistant Claims Examiner - Remote or Hybrid in CA

Position Assistant Claims Examiner - Remote or Hybrid in CALocation Concord, CA. Employees living within 26 miles of the Concord or Orange offices are required to work onsite one day per week (Tuesday‐Thursday) and may remote the remaining days. Remote work is allowed for employees residing in California and meeting technical requirements.Position Summary Athens Administrators needs an experienced Assistant Claims Examiner to support the Workers' Compensation department. The schedule is Monday‐Friday, 37.5 hours per week with optional flex schedule. The role includes clerical and technical assistance to Senior Claims Examiners, administration of Medical‐Only claims, ensuring timely processing of claims and payment of benefits, managing medical treatment, and setting reserves.Primary ResponsibilitiesProcess new claims in compliance with client's Service AgreementIssue all indemnity payments and awards on timeProcess all approved provider bills timelyPrepare objection letters to providers for medical bills; delayed, denied, lacking reports.Answer questions over the phone from medical providers regarding billsContact treating physician for disability statusContact employer for return‐to‐work status or availability of modified work.Contact injured worker at initial set upSend DWC notices timelyIssue SJDB Notices timelyRequest Job Description from EmployerHandle Medical‐Only claim filesCalculate wage statements and adjust disability rates as requiredKeep diary for all delay dates and indemnity paymentsDocuments file activity on computerUpdate information on computer, i.e., address changes, etc.Schedule appointments for AME, QME evaluationsSend appointment letters, issue TD/mileage, send medical fileRequest Employer's Report, DWC‐1, Doctor's First Report if neededVerify mileage and dates of treatment for reimbursement to claimantSubpoena recordsFile and serve documents on attorneys, WCAB, doctorsServe PTP's with medical file and Duties of Treating Physician (9785)Request PD ratings from DEUDraft Stipulated Awards and C&R'sSubmit C&R, Stipulated Awards to WCAB for approval with documentationProcess checks – stop payment, cancellations, void, journal paymentsHandle telephone calls for examiner as neededComplete penalty calculations and prepare penalty worksheetsComplete MPN, HCO and/or EDI codingComplete referrals to investigatorsComplete preparation of documents for overnight deliveryWork collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims ExaminersContact with clients, injured workers, attorneys, doctors, vendors, and other partiesProvide updates of claims status to Senior Claims Examiners and Athens managementPrepare professional, well‐written correspondence and other communicationsEssential Position RequirementsHigh School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required2+ years' Claims Assistant experience supporting a workers compensation examiner or team preferredMedical Only Adjuster designation requiredContinuing hours must be currentMathematical calculating skillsCompletion of IEA or equivalent coursesAdministrators Certificate from Self‐Insurance Plans preferredKnowledge of workers compensation laws, policies, and proceduresUnderstanding of medical and legal terminologyMust demonstrate accuracy and thoroughness in work productAbility to sit for prolonged periods of timeWell‐developed verbal and written communication skills with strong attention to detailExcellent organizational skills and ability to multi‐taskAbility to type quickly, accurately and for prolonged periodsProficient in Microsoft Office SuiteAbility to learn additional computer programsReasoning 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 resolutionAbility to be trustworthy, dependable, and team‐oriented for fellow employees and the organizationSeeks to include innovative strategies and methods to provide a high level of commitment to service and resultsAbility to demonstrate care and concern for fellow team members and clients in a professional and friendly mannerActs with integrity in difficult or challenging situations and is a trustworthy, dependable contributorAthens' operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.Must be able to reliably commute to meetings and events as required by this positionApply With Us We look forward to learning about you. Submit your résumé and application directly through our website: http://www.athensadmin.com/careers/job-openings. Cover letter optional. All applications are reviewed by our in‐house Corporate Recruitment team. We 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: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdfEqual Employment Opportunity 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.Benefits 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. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. 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! Further information about our comprehensive benefits package may be found on our website: https://www.athensadmin.com/careers/why-work-hereThank 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!#J-18808-Ljbffr