Assistant Claims Examiner

Assistant Claims Examiner

Company: Athens Administrators

This role offers a competitive salary range between $28.00/hr and $31.00/hr
.

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 is a dynamic, innovative leader in claims administration since 1976. We foster an inclusive culture with opportunities for professional growth. Our nationwide, family‑owned company specializes in Workers' Compensation, Property & Casualty, Program Business, and Managed Care.

The Assistant Claims Examiner supports the Workers’ Compensation department and is eligible to work from any California location. Employees within 26 miles of the Concord or Orange offices must visit once a week. The role involves clerical and technical assistance to Senior Claims Examiners, administration of Medical‑Only claims, and management of medical treatment and reserves.

• Process new claims in compliance with client Service Agreements
• Issue all indemnity payments and awards on time
• Process all approved provider bills promptly
• Prepare objection letters to providers for delayed, denied, or incomplete medical bills
• Answer phone inquiries from medical providers regarding bills
• Contact treating physicians about disability status
• Contact employers for return‑to‑work status or modified work availability
• Contact injured workers during initial setup
• Send DWC notices promptly
• Issue SJDB notices promptly
• Request job descriptions from employers
• Handle Medical‑Only claim files
• Calculate wage statements and adjust disability rates as required
• Maintain a diary of all delay dates and indemnity payments
• Document file activity on computer
• Update address and contact information on computer
• Schedule appointments for AME and QME evaluations
• Send appointment letters, issue TD/mileage, and forward medical files
• Schedule interpreters for appointments and depositions
• Request employer’s reports (DWC‑1, first report, etc.) if needed
• Verify mileage and treatment dates for claimant reimbursement
• Serve subpoenas for records
• File and serve documents with attorneys, WCAB, and doctors
• Serve PTPs with medical files and Duties of Treating Physician (9785)
• Request PD ratings from DEU
• Draft stipulated awards and C&R’s
• Submit C&R and stipulated awards to WCAB for approval with documentation
• Process checks: stop payments, cancellations, voids, journal entries
• Handle telephone calls for the examiner as needed
• Complete penalty calculations and prepare penalty worksheets
• Complete MPN, HCO, or EDI coding
• Complete referrals to investigators
• Prepare documents for overnight delivery
• Collaborate with Senior Claims Examiners, Nurse Case Managers, and other Assistants
• Communicate with clients, injured workers, attorneys, doctors, vendors, and other parties
• Provide status updates to Senior Examiners and Athens management
• Prepare professional, well‑written correspondence and communications

• High School Diploma or equivalent (GED) required; AA/AS or BA/BS preferred but not required
• Minimum 2 years’ Claims Assistant experience supporting a Workers’ Compensation examiner or team preferred
• Medical‑Only Adjuster designation required
• Continuing education hours must be current
• Strong mathematical and calculation 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
• Demonstrated accuracy and thoroughness in work product
• Ability to sit for prolonged periods
• Excellent verbal and written communication skills with strong attention to detail
• Excellent organizational skills and ability to multi‑task
• Typing speed: quick, accurate, for prolonged periods
• Proficient in Microsoft Office Suite
• Ability to learn additional computer programs
• Strong reasoning, problem‑solving, and analytical skills
• Dependable and team‑oriented
• Innovative approach to service and results
• Considerate and courteous to team…