Workers Compensation Senior Claims Examiners (Ventura, CA)

California, Ventura county Ventura county USA

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ATHENS ADMINISTRATORS

Since 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 benefitsevery single day. With four offices in California, two in Texas, one in New Jersey, and one Florida; Athens Administrators offers Workers' Compensation, Property & Casualty, Managed Care and Program Business solutions. Athens is very proud to be a family-run company for over 40 years offering a caring and engaging culture and environment to employees at all levels.

JOB SUMMARY

Athens Administrators has an immediate need for a full-time Senior Claims Examiner to support our Ventura, CA office. 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.

PRINCIPAL DUTIES AND RESPONSIBILITIES

Incumbent must have the skills, ability and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation:

ïƒ Establish contact with employer to review issues

ïƒ Respond to inquiries from the employer, employee, doctors and attorneys

ïƒ Establish and maintain appropriate reserves

ïƒ Review legal correspondence and medical reports

ïƒ Evaluate and approve medical procedures and treatment

ïƒ Administer benefits and ensure appropriateness of all payments

ïƒ Investigate coverage, liability and monetary value of claim

ïƒ Review medical and legal bills for appropriateness

ïƒ Discuss appropriateness of medical treatment with medical case manager

ïƒ Determine compensability

ïƒ Monitor and assist litigation

ïƒ Negotiate settlement of claim, liens, rehabilitation plans, etc

ïƒ Prepare and present reports to clients

ïƒ Appropriately close claims

ïƒ Help resolve client billing and payment inquiries

ïƒ Investigate complaints from injured workers

ïƒ Document and code the claim files and claims system with all relevant information

ïƒ Maintain and update action plans within specified time frames

ïƒ Provide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasks

ïƒ Contact with employers, employees, attorneys, doctors, vendors and other parties

ïƒ Provide customer service and support to clients and claimants

ïƒ Work collaboratively with attorneys to draft settlements and assist with litigation strategies

ïƒ Negotiate settlements

ïƒ Authorize and negotiate cost of medical treatment and supplies

ïƒ Internal communication with staff

ïƒ Prepare professional, well written correspondence and other communications

ESSENTIAL JOB REQUIREMENTS

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

ïƒ High school diploma required, college degree preferred

ïƒ Administrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtained.

ïƒ 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)

ïƒ 3+ years recent workers compensation claims handling experience

ïƒ JPA experience strongly preferred

ïƒ Bilingual Spanish strongly preferred

ïƒ Solid knowledge of workers compensation laws, policies and procedures

ïƒ Well-developed verbal and written communication skills

ïƒ Strong attention to detail and the ability to research and resolve problems

ïƒ Excellent organizational skills

ïƒ Ability to manage multiple tasks simultaneously

ïƒ Ability to work independently and in a group setting

ïƒ Ability to operate standard office equipment (fax, phone, printer, scanner, etc.)

ïƒ Ability to work in a paperless environment

ïƒ Ability to type quickly, accurately and for prolonged periods

ïƒ Must demonstrate accuracy and thoroughness in work product

ïƒ Ability to sit for prolonged periods of time

ïƒ Infrequent lifting of up to 20lbs may be required

ïƒ Computer literate and experience navigating various computer systems, including MS Word, Excel and Outlook and database management.

ïƒ SIMS program experience preferred but not required

ïƒ Ability to learn additional computer programs

ïƒ Completion of IEA or equivalent courses

ïƒ 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

ïƒ Proficiency in determining case value and negotiating settlements

ïƒ Understanding of medical and legal terminology

ïƒ Mathematical calculating skills

ïƒ Proven ability to analyze facts, identify issues and make appropriate recommendations and solutions for resolution

ïƒ Ability to carefully review records prior to sending to correct parties

ïƒ Valid Driver's license and availability for local travel

APPLICATION INSTRUCTIONS

In 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 CLOSING

We 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!

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Job Details

ID #1708669
State California
City Ventura county
Full-time
USD
Source California
Showed 2019-02-12
Date 2019-01-24
Deadline 2019-03-25
Category Et cetera