Assistant Claims Examiner - Remote or Hybrid
ATHENS POSITION DETAILS Position Title Assistant Claims Examiner Department Workers’ Compensation Reports To Claims Supervisor FLSA Status Non-Exempt Job Grade 6 Career Ladder Next step in progression could include Future Medical Examiner or Claims Examiner Trainee ATHENS ADMINISTRATORS Explore the Athens Administrators difference We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY 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, however, 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. Athens offices are open for business Monday-Friday from 730 a.m. to 530 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 Assistant Claims Examiner will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves. 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
- 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
- Documents 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 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.
- 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
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