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 SUMMARYAthens 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 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:Establish contact with employer to review issuesRespond to inquiries from the employer, employee, doctors, and attorneysEstablish and maintain appropriate reservesReview legal correspondence and medical reportsEvaluate and approve medical procedures and treatmentAdminister benefits and ensure appropriateness of all paymentsInvestigate coverage, liability and monetary value of claimReview medical and legal bills for appropriatenessDiscuss appropriateness of medical treatment with medical case managerDetermine compensabilityMonitor and assist litigationNegotiate settlement of claim, liens, rehabilitation plans, etc.Prepare and present reports to clientsAppropriately close claimsHelp resolve client billing and payment inquiries Investigate complaints from injured workersDocument and code the claim files and claims system with all relevant informationMaintain and update action plans within specified time framesProvide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasksContact with employers, employees, attorneys, doctors, vendors and other partiesProvide customer service and support to clients and claimantsWork collaboratively with attorneys to draft settlements and assist with litigation strategiesNegotiate settlementsAuthorize and negotiate cost of medical treatment and suppliesInternal communication with staffPrepare professional, well written correspondence and other communicationsESSENTIAL POSITION REQUIREMENTSThe 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 positionsAA/AS or BA/BS preferred but not requiredAdministrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtainedMust 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 requiredAt least 5 years of workers compensation claims experience preferredSolid knowledge of workers compensation laws, policies and procedures’Completion of IEA or equivalent coursesProficiency in determining case value and negotiating settlementsUnderstanding of medical and legal terminologyMathematical calculating skillsAPPLY WITH USWe 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.pdfTHANK 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!