Hearing Representative Workers

ABOUT US:

Ethos Risk Services is a leading provider of workers compensation medical management investigations and claims solutions dedicated to helping clients make better decisions through industry expertise innovation and exceptional service. As we continue to grow were expanding our cost containment capabilities through Definiti a national leader in medical bill review pharmacy benefit management PPO network solutions and reimbursement services. Together were building a comprehensive suite of solutions that helps clients reduce costs improve efficiency and achieve better claim outcomes.

JOB SUMMARY:

Our dynamic Bill Review team is seeking a full-time Hearing Representative to represent our organization and clients throughout the California workers compensation lien resolution process. This role is responsible for resolving complex lien disputes negotiating settlements preparing legal documentation and supporting administrative hearings while partnering closely with providers attorneys claims professionals and bill review teams.

Our ideal candidate has experience in California workers compensation strong analytical and negotiation skills and enjoys solving complex reimbursement challenges in a fast-paced environment .

KEY RESPONSIBILITIES:

• Attend Hearings Participate in California Workers Compensation Appeals Board (WCAB) lien conferences settlement conferences status conferences and lien trials while representing client interests.
• Represent Clients Advocate on behalf of Ethos and its clients during lien proceedings negotiations and administrative hearings.
• Negotiate Settlements Work directly with providers attorneys and hearing representatives to resolve disputed liens and achieve favorable settlement outcomes.
• Review & Resolve Appeals Evaluate provider appeals reconsideration requests and disputed lien claims while identifying appropriate resolutions.
• Prepare Legal Documentation Draft Minutes of Hearing appeal responses hearing exhibits and other supporting legal documentation.
• Research Regulations Interpret California workers compensation statutes fee schedules regulations and case law to support case strategy and compliance.
• Support Litigation Assist attorneys with hearing preparation case analysis and litigation support activities.
• Perform Technical Bill Review Analyze workers compensation medical bills reimbursement issues and complex payment disputes.
• Manage Complex Cases Maintain accurate documentation prioritize multiple cases and ensure deadlines are consistently met.
• Collaborate Across Teams Partner with claims professionals bill review operations providers attorneys and internal stakeholders to deliver timely and effective claim resolutions.

QUALIFICATIONS:

Education: High school diploma or equivalent (required). Associates degree or higher is preferred.

Experience:

• Minimum of 2 to 5 years of experience in workers compensation legal assistant paralegal claims hearing representative lien resolution litigation support or related experience (required).
• Experience with Californias workers compensation lien procedure and regulations (required).
• Experience attending WCAB proceedings negotiating liens preparing hearing exhibits responding to provider disputes and handling appeals (preferred).
• Experience preparing legal exhibits and hearing documentation (preferred).
• Experience in Conduent Strataware software (preferred).

Certifications: Certification in medical cording or medical terminology (preferred).

Skills:

• Excellent negotiation and conflict resolution skills
• Strong written and verbal communication
• Ability to analyze medical billing reimbursement and regulatory issues
• Excellent organizational time management and prioritization skills

WORKING CONDITIONS:

This position offers flexible work arrangements including hybrid or full on-site options based on business needs and management approval. The office is located at 26445 Rancho Parkway Street Lake Forest CA 92630 .

Flexible start times are available between 6:00 a.m. and 9:00 a.m. with eligibility for a 9/80 alternate work schedule (every other Monday or Friday off) following successful completion of training satisfactory performance business needs and management approval. Occasional travel and overnight stay may be required to attend California Workers Compensation Appeals Board (WCAB) proceedings.

Ethos Risk Services and Definiti Comp Solutions is an equal opportunity employer that does not discriminate on the basis of religious creed sex national origin race veteran status disability age marital status color or sexual orientation or any other characteristic .

Required Experience:

Unclear Seniority