Assistant Claims Examiner Details

Assistant Claims Examiner

Athens Administrators - Concord, CA

Employment Type : Full-Time

Athens AdministratorsJob DescriptionJob Title: Assistant Claims Examiner Department: Workers’ Compensation Reports To: Claims Supervisor FLSA Status: Non-Exempt Job Class: 8 ATHENS COMPANY DETAILSSince our founding in 1976, Athens Administrators has been a recognized leader in third party claims administration services. But more important than what we do is how we do it. We provide service that translates into real and lasting benefits—every single day. With offices in California, Texas, New Jersey, and Florida; Athens Administrators offers Workers’ Compensation, Property & Casualty, Managed Care and Program Business solutions. Athens is proud to be a family-owned company and is dedicated to its core values of honesty and integrity, a commitment to service and results, and a caring family culture. JOB SUMMARYAthens Administrators has an immediate need for a full-time Assistant Claims Examiner to support our Concord office located on Stanwell Drive. Please note, this position will work from home during quarantine but once deemed safe, will be in the Concord office full-time. The schedule for this position is Monday-Friday at 37.5 hours a week. The Assistant Claims Examiner will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing and directing medical treatment, and setting reserves. PRINCIPAL DUTIES AND RESPONSIBILITIESIncumbent must have the skills, ability and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation:

• 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
• Schedule interpreter for appointments, depositions, etc.
• 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

ESSENTIAL JOB REQUIREMENTSThe requirements listed below are representative of the knowledge, skill, and/or ability required.

• High school diploma required, college degree preferred
• Completion of IEA or equivalent courses
• Administrators Certificate from Self-Insurance Plans preferred
• Experienced Indemnity Claims Adjuster Designation preferred
• Knowledge of workers compensation laws, policies and procedures
• Understanding of medical and legal terminology
• Well-developed verbal and written communication skills
• Strong attention to detail and the ability to research and resolve problems
• Excellent organizational skills
• Ability to manage multiple tasks simultaneously
• Ability to work independently and in a group setting
• Ability to operate standard office equipment (fax, phone, printer, scanner, etc.)
• Ability to work in a paperless environment
• Ability to type quickly, accurately and for prolonged periods
• Must demonstrate accuracy and thoroughness in work product
• Ability to sit for prolonged periods of time
• Infrequent lifting of up to 20lbs may be required

• Computer literate and experience navigating various computer systems, including MS Word, Excel and Outlook and database management with the ability to learn additional computer programs
• Understanding of medical and legal terminology
• Reasoning ability, including problem solving and analytical skills, i.e., proven ability to analyze facts, identify issues and make appropriate recommendations and solutions for resolution
• Ability to carefully review records prior to sending to correct parties
• Mathematical calculating skills

APPLICATION INSTRUCTIONSIn order to be considered, please submit your resume, cover letter, and application directly through our website at http://www.athensadmin.com/careers/job-openings/ All applications received are reviewed by our in-house Corporate Recruiter. This description portrays in general terms the type and levels of work performed and is not intended to be all-inclusive or represent specific duties of any one incumbent. The knowledge, skills, and abilities may be acquired through a combination of formal schooling, self-education, prior experience, or on-the-job training. 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. IN CLOSINGWe look forward to reviewing your information. Don’t forget to check out our website at www.athensadmin.com as well as our LinkedIn and Facebook pages!