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Senior Claims Examiner - Remote from Southern California

Company: Athens Administrators
Location: Orange
Posted on: September 23, 2022

Job Description:

Athens Position Details

Position Title: Senior Claims Examiner

Department: Workers' Compensation

Reports To: Claims Supervisor

FLSA Status: Non-Exempt

Job Grade: 12


Since our founding in 1976, Athens Administrators has been a recognized leader in third-party claims administration services. However, more important than what we do is how we do it. Athens employees provide service that translates into real and lasting benefits-every single day! With offices throughout the United States, Athens Administrators offers Workers' Compensation, Property & Casualty, Managed Care and Program Business solutions. Athens is proud to be a third-generation 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. We are so proud that our employees have consistently voted Athens as a Best Place to Work!


Athens Administrators has an immediate need for a Senior Claims Examiner to support our Workers Compensation department and can be located remotely in Southern California if technical requirements are met. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time.

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.


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:

Respond to inquiries from the employer, employee, doctors and attorneys
Establish and maintain appropriate reserves
Administer benefits and ensure appropriateness of all payments
Discuss appropriateness of medical treatment with medical case manager
Determine compensability
Negotiate settlement of claim, liens, rehabilitation plans, etc
Prepare and present reports to clients
Document and code the claim files and claims system with all relevant information
Maintain and update action plans within specified time frames
Negotiate settlements


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.

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
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
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

Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
Valid Driver's license and availability for local travel


We look forward to learning about YOU! To be considered, please submit your resume and application directly through our website at Feel free to include a cover letter if you'd like to share any other details. 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.


We look forward to reviewing your information. Applying for jobs isn't necessarily fun, but we promise we are. Don't forget to check out our website at as well as our LinkedIn, Glassdoor, and Facebook pages!


Keywords: Athens Administrators, Orange , Senior Claims Examiner - Remote from Southern California, Other , Orange, California

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