- Bachelor's Degree
- High School Diploma or GED
- Basic Computer Skills
- Microsoft Word
- Workers Compensation
Job Title: Assistant Claims Examiner
Department: Workers’ Compensation
Reports To: Claims Supervisor
FLSA Status: Non-Exempt
ATHENS COMPANY DETAILS
Since our founding in 1976, Athens Administrators has been a recognized leader in third party claims administration services. But more important than what we do is how we do it. We provide service that translates into real and lasting benefits—every single day! With four offices in California, two in Texas, one in New Jersey, and one Florida, Athens Administrators offers Workers’ Compensation, Property & Casualty, Managed Care and Program Business solutions. Athens is very proud to be a family-run company for over 40 years offering a caring and engaging culture and environment to employees at all levels.
Athens Administrators has an immediate need for a full-time Assistant Claims Examiner to support our Concord office located on Stanwell Drive. The schedule for this position is Monday-Friday at 37.5 hours a week. 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.
PRINCIPAL DUTIES AND RESPONSIBILITIES
Incumbent must have the skills, ability and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation:
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
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 JOB REQUIREMENTS
The requirements listed below are representative of the knowledge, skill, and/or ability required.
High school diploma required, college degree preferred
Completion of IEA or equivalent courses
Administrators Certificate from Self-Insurance Plans preferred
Experienced Indemnity Claims Adjuster Designation preferred
Knowledge of workers compensation laws, policies and procedures
Understanding of medical and legal terminology
Well-developed verbal and written communication skills
Strong attention to detail and the ability to research and resolve problems
Excellent organizational skills
Ability to manage multiple tasks simultaneously
Ability to work independently and in a group setting
Ability to operate standard office equipment (fax, phone, printer, scanner, etc.)
Ability to work in a paperless environment
Ability to type quickly, accurately and for prolonged periods
Must demonstrate accuracy and thoroughness in work product
Ability to sit for prolonged periods of time
Infrequent lifting of up to 20lbs may be required
Computer literate and experience navigating various computer systems, including MS Word, Excel and Outlook and database management with the ability to learn additional computer programs
Understanding of medical and legal terminology
Mathematical calculating skills
Computer processing skills
In order to be considered, please submit your resume, cover letter, and application directly through our website at http://www.athensadmin.com/careers/job-openings/
This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training.
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.
We look forward to reviewing your information. Don’t forget to check out our website at www.athensadmin.com as well as our LinkedIn and Facebook pages!