Athens Administrators · 2 days ago
Assistant Claims Examiner
California, United States
Full-time
Hybrid
Entry Level
$28/hr - $31/hr
2+ years expAthens Administrators is a dynamic leader in claims administration, seeking an experienced Assistant Claims Examiner for their Workers’ Compensation department. The role involves providing clerical and technical assistance to Senior Claims Examiners, processing Medical Only claims, and ensuring timely claims processing and benefit payments.
ComplianceFinancial ServicesInsuranceProperty Insurance
Responsibilities
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
Qualification
Required
High School Diploma or equivalent (GED) required for all positions
Medical Only Adjuster designation required
Continuing hours must be current
Mathematical calculating skills
Completion of IEA or equivalent courses
Knowledge of workers compensation laws, policies, and procedures
Understanding of medical and legal terminology
Must demonstrate accuracy and thoroughness in work product
Ability to sit for prolonged periods of time
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
Must be able to reliably commute to meetings and events as required by this position
Preferred
AA/AS or BA/BS preferred but not required
2+ years' Claims Assistant experience supporting a workers compensation examiner or team preferred
Administrators Certificate from Self-Insurance Plans preferred
Benefits
Medical
Vision
Dental
Life and AD&D
Long Term Care
Critical Care
Accidental
Hospital Indemnity
HSA & FSA options
401k (and Roth)
Company-Paid STD & LTD
Company
Athens Administrators
Athens Administrators is an insurance firm that offers worker's compensation, program business, managed care, property & casualty services.
501-1000 employees
Funding
Current Stage
Late StageRecent News
2025-11-09
2025-11-07
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