Senior Claims Examiner - Flex Multi-Account

Senior Claims Examiner – Flex Multi‑Account

Athens Administrators

Location:

California (anywhere within the state, with occasional in‑office presence at Concord or Orange – once a week).

Pay: $50.00–$56.00 per hour.

The Senior Claims Examiner – Flex will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing medical treatment, setting reserves, and negotiating settlements for a variety of teams and clients at Athens.

• Establish contact with employer to review issues.
• Respond to inquiries from employer, employee, doctors, and attorneys.
• Establish and maintain appropriate reserves.
• Review legal correspondence and medical reports.
• Evaluate and approve medical procedures and treatment.
• Administer benefits and ensure appropriateness of all payments.
• Investigate coverage, liability, and monetary value of claim.
• Review medical and legal bills for appropriateness.
• Discuss appropriateness of medical treatment with medical case manager.
• Determine compensability.
• Monitor and assist litigation.
• Negotiate settlement of claim, liens, rehabilitation plans, etc.
• Prepare and present reports to clients.
• Appropriately close claims.
• Help resolve client billing and payment inquiries.
• Investigate complaints from injured workers.
• Document and code claim files in the claims system with all relevant information.
• Maintain and update action plans within specified time frames.
• Provide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed.
• Contact employers, employees, attorneys, doctors, vendors, and other parties.
• Provide customer service and support to clients and claimants.
• Work collaboratively with attorneys to draft settlements and assist with litigation strategies.
• Negotiate settlements.
• Authorize and negotiate cost of medical treatment and supplies.
• Prepare professional, well‑written correspondence and other communications.

• High School Diploma or equivalent (GED) required for all positions
  • AA/AS or BA/BS preferred but not required.
• Administrators Certificate from Self‑Insurance Plans required within one year of employment if not already obtained.
• Must possess a current Experienced Indemnity Claims Adjuster Designation.
• 3+ years recent workers compensation claims handling experience required.
• At least 5 years of workers compensation claims experience preferred.
• Solid knowledge of workers compensation laws, policies, and procedures.
• Completion of IEA or equivalent courses.
• Proficiency in determining case value and negotiating settlements.
• Understanding of medical and legal terminology.
• Mathematical calculating skills.
• Well‑developed verbal and written communication skills with strong attention to detail.
• Excellent organizational skills and ability to multi‑task.
• Ability to type quickly, accurately and for prolonged periods.
• Proficient in Microsoft Office Suite
  • Ability to learn additional computer programs.
• Reasoning ability, including problem‑solving and analytical skills.
• Ability to be trustworthy, dependable, and team‑oriented.
• Seeks to include innovative strategies and methods to provide a high level of commitment to service and results.
• Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner.
• Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor.
• Maintaining honesty and integrity is essential for all roles.
• Must be able to reliably commute to meetings and events as required.

We 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. Submit your resume and application directly through our website at  and feel free to include a cover letter.

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.