Assistant Claims Examiner - Remote or Hybrid in CA

Position

Assistant Claims Examiner - Remote or Hybrid in CA

Concord, CA. Employees living within 26 miles of the Concord or Orange offices are required to work onsite one day per week (Tuesday‑Thursday) and may remote the remaining days. Remote work is allowed for employees residing in California and meeting technical requirements.

Athens Administrators needs an experienced Assistant Claims Examiner to support the Workers’ Compensation department. The schedule is Monday‑Friday, 37.5 hours per week with optional flex schedule. The role includes clerical and technical assistance to Senior Claims Examiners, administration of Medical‑Only claims, ensuring timely processing of claims and payment of benefits, managing medical treatment, and setting reserves.

• 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
• 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

• 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 and legal terminology
• Must demonstrate accuracy and thoroughness in work product
• Ability to sit for prolonged periods of time
• 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, i.e., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution
• Ability to be trustworthy, dependable, and team‑oriented for fellow employees and the organization
• 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…