Senior Claims Examiner

Overview The Athens Administrators is a nationwide, family-owned company providing workers' compensation, property & casualty, program business, and managed care services. We seek exceptional professionals to join our team and offer opportunities for continuous professional growth in a supportive, inclusive culture. Location: Northern California, CA Job Id: 1556 # of Openings: 1 FLSA Status: Non-Exempt Job Grade: 12 Next step in progression could include Lead Senior Claims Examiner or Claims Supervisor ATHENS ADMINISTRATORS Athens Administrators has been a dynamic, innovative leader in claims administration since 1976. We foster an environment where employees thrive and Athens is recognized as a “Best Place to Work.” Join our nationwide family-owned company and support Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Position Details Position Title: Department: Reports To: Job Summary: Senior Claims Examiner to support our workers' compensation offices. This full-time role can be located anywhere in California; employees living within 26 miles of Concord, CA or Orange, CA offices are required to work in the office one day per week (Tuesday–Thursday). Remaining days may be remote if technical requirements are met and the employee resides in California. Office hours are Monday–Friday, 7:30 a.m. to 5:30 p.m. local time. Schedule: Monday–Friday, 37.5 hours per week with a flex option. Role Focus: Adjust workers’ compensation claims from inception through settlement and closure, ensure timely processing of claims and payment of benefits, manage medical treatment, set reserves, and negotiate settlements. Responsibilities Establish contact with employer to review issues Respond to inquiries from the 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 the claim Review medical and legal bills for appropriateness Discuss appropriateness of medical treatment with medical case manager Monitor and assist litigation Negotiate settlement of claims, 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 with all relevant information Maintain and update action plans within specified time frames Provide direction to Claims Assistants and Claims Technicians; assist with training and mentoring Coordinate 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 the cost of medical treatment and supplies Internal communication with staff Prepare professional, well-written correspondence and other communications Qualifications Essential Position Requirements The following are representative of the knowledge, skills, and abilities required. This is not an exhaustive list. 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) as defined in California Code of Regulations 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 Strong verbal and written communication skills with attention to detail Excellent organizational skills and ability to multi-task Typing proficiency Proficient in Microsoft Office Suite with ability to learn additional programs Strong reasoning, problem-solving, and analytical abilities Trustworthy, dependable, and team-oriented Willingness to implement innovative strategies to deliver service and results Professional and friendly to colleagues and clients Demonstrates integrity in challenging situations Ability to handle confidential information with discretion Reliable commuting to meetings/events as required Apply Apply with us We invite you to apply via our website at You may include a cover letter if desired. All applications are reviewed by our in-house Corporate Recruitment team. The company complies with applicable Fair Chance laws. Learn more about these rights here: Legal notices This description is not exhaustive or all-inclusive of duties and responsibilities. Athens Administrators is an Equal Opportunity/ Affirmative Action employer. We do not discriminate on the basis of race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or other legally protected status. Thank you We appreciate your time and invite you to visit our website at and our LinkedIn, Glassdoor, and Facebook pages for more information. Compensation Athens Administrators offers competitive compensation and a comprehensive benefits package, which may include Medical, Vision, Dental, Life and AD&D, Long Term Care, etc. Details are available on our careers page: How to Apply Application Process: If qualified for a current open position, click the job title, review details, and select “Apply for this Position” to upload your resume (and optional cover letter) and answer brief questions. After You Apply: You will receive an email confirming receipt. Our Recruitment Team will review your materials and contact you if your background matches. Interviewing Process: Interviews may be conducted by phone, Zoom, or in person with the Recruitment Team and/or hiring manager. Thank you for your interest in joining the Athens family. We look forward to reviewing your information! #J-18808-Ljbffr