Bilingual Senior Claims Examiner - California Only
Athens Administrators, California, MO, United States
Athens Administrators has an immediate need for a full-time Bilingual Senior Claims Examiner to support our workers compensation offices and can be located anywhere in Southern California, however, employees who live less than 26 miles from the Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday – Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in Southern California. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The Senior Claims Examiner will adjust workers’ compensation claims from inception through settlement and closure, ensuring timely processing of claims and payment of benefits, managing and directing medical treatment, setting reserves, and negotiating settlements. They will use fluent Spanish skills with claimants on the account.
PRIMARY RESPONSIBILITIES
Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
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 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
Aappropriately 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 and assist with training, coaching, and mentoring as needed for them to support daily claims tasks
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 listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
Fluency in Spanish required
High School Diploma or equivalent (GED) required for all positions
AA/AS or BA/BS preferred but not required
Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained
Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f)
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
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 fellow team members and clients in a professional and friendly manner
Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor.
Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
Must be able to reliably commute to meetings and events as required by this position
#J-18808-Ljbffr
PRIMARY RESPONSIBILITIES
Our new hire should have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Additional duties may be assigned:
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 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
Aappropriately 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 and assist with training, coaching, and mentoring as needed for them to support daily claims tasks
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 listed below are representative of the knowledge, skill, and/or ability required. While it does not encompass all job requirements, it is meant to give you a solid understanding of expectations.
Fluency in Spanish required
High School Diploma or equivalent (GED) required for all positions
AA/AS or BA/BS preferred but not required
Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained
Must possess a current Experienced Indemnity Claims Adjuster Designation, provided by an insurer, as defined in California Code of Regulations, Title 10, Chapter 5, Subchapter 3, Section 2592.01(f)
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
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 fellow team members and clients in a professional and friendly manner
Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor.
Athens’ operations involve handling confidential, proprietary, and highly sensitive information, such as health records, client financials, and other personal data. Therefore, maintaining honesty and integrity is essential for all roles within the company.
Must be able to reliably commute to meetings and events as required by this position
#J-18808-Ljbffr