Bilingual Senior Claims Examiner

Overview ATHENS ADMINISTRATORS — We have been dynamic, innovative leaders in claims administration since 1976. We foster an environment where employees thrive and are recognized as a “Best Place to Work.” Join our nationwide family-owned company in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. This description portrays general terms of work performed and is not all-inclusive. Location: Southern California, CA Job Id: 1569 # of Openings: 1 Position Title: Senior Claims Examiner – Bilingual (Spanish) Department: (not specified) Reports To: (not specified) FLSA Status: Non-Exempt Job Grade: 12 Next step in progression: Lead Senior Claims Examiner or Claims Supervisor Position Summary Athens Administrators has an immediate need for a full-time Bilingual Senior Claims Examiner to support our workers compensation offices. The position can be located anywhere in California; employees living within 26 miles of Concord, CA or Orange, CA offices are expected to work one day per week in the office (Tuesday–Thursday, schedule determined by supervisor). Remote work is possible on other days if technical requirements are met. Office hours are Monday–Friday, 7:30 a.m.–5:30 p.m. local time. The schedule is Monday–Friday at 37.5 hours/week with a flex option. The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensure timely processing and payment of benefits, manage medical treatment, set reserves, and negotiate settlements. Fluency in Spanish is required for claimant interactions on the account. Primary Responsibilities 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 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 the claim files and claims system with all relevant information Maintain and update action plans within specified time frames Provide direction to Claims Assistants and Claims Technicians; assist with training, coaching, and mentoring as needed Contact with 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 Internal communication with staff Prepare professional, well-written correspondence and other communications Essential Position Requirements The requirements below represent knowledge, skills, and abilities for this role. This list is not all-inclusive. Fluency in Spanish required High School Diploma or equivalent (GED) required 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 Current Experienced Indemnity Claims Adjuster Designation (California) 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 calculation skills Well-developed verbal and written communication skills with attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly and accurately Proficient in Microsoft Office Suite; ability to learn additional programs Analytical and problem-solving abilities; ability to research and recommend solutions Trustworthy, dependable, and team-oriented Commitment to service and results; innovative approach Professional, respectful demeanor toward colleagues and clients Integrity in handling confidential information Ability to commute to meetings/events as required Benefits & Compensation Athens Administrators is dedicated to fair and equitable compensation. The estimated pay rate varies by skills, knowledge, location, and experience. Eligible employees may receive discretionary salary adjustments and/or incentive payments. We offer a comprehensive benefits package including Medical, Vision, Dental, Life and AD&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA, 401k (and Roth), and Company-Paid STD & LTD, among others. Details available on our website. Apply Submit your resume and application through our website at . You may include a cover letter. All applications are reviewed by our Corporate Recruitment team. We comply with applicable fair chance laws. More information about our policies is available on our website. This description covers general terms of work and may not include every duty or responsibility. Athens Administrators is an Equal Opportunity/Affirmative Action employer. We provide equal employment opportunities to all qualified applicants regardless of race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. #J-18808-Ljbffr ATHENS ADMINISTRATORS