Experienced Claims Specialist
2 weeks ago
POSITION OVERVIEW
Athens Administrators is seeking a dedicated Bilingual Senior Claims Adjuster to join our team, supporting our workers' compensation operations. This role offers the flexibility of working remotely or in a hybrid capacity, catering to candidates across California. The work schedule is Monday to Friday, totaling 37.5 hours per week, with options for flexible hours. The Senior Claims Adjuster will be responsible for managing workers' compensation claims from initiation to resolution, ensuring prompt processing and payment of benefits, overseeing medical treatment, establishing reserves, and negotiating settlements. Proficiency in Spanish is essential for effective communication with claimants.
KEY RESPONSIBILITIES
The ideal candidate will possess the necessary skills and judgment to perform the following essential duties:
- Engage with employers to address and resolve issues
- Respond to inquiries from employers, employees, medical professionals, and legal representatives
- Establish and maintain appropriate financial reserves
- Review legal documents and medical evaluations
- Assess and authorize medical treatments and procedures
- Administer benefits and ensure the accuracy of all payments
- Investigate coverage, liability, and the financial implications of claims
- Evaluate medical and legal invoices for correctness
- Consult with medical case managers regarding treatment appropriateness
- Determine the compensability of claims
- Monitor and support litigation processes
For a comprehensive list of responsibilities, please refer to our website.
ESSENTIAL QUALIFICATIONS
The following qualifications are representative of the knowledge, skills, and abilities required for this position:
- Fluency in Spanish is mandatory
- A High School Diploma or equivalent (GED) is required
- Associate's or Bachelor's degree is preferred but not mandatory
- Certification from Self-Insurance Plans must be obtained within one year of employment if not already held
- Current Experienced Indemnity Claims Adjuster Designation is required as per California regulations
- A minimum of 3 years of recent experience in handling workers' compensation claims is required
- At least 5 years of experience in workers' compensation claims is preferred
- Strong understanding of workers' compensation laws, policies, and procedures
- Completion of IEA or equivalent courses is advantageous
- Proficiency in assessing case values and negotiating settlements
For a full list of qualifications, please visit our website.
JOIN OUR TEAM
We are eager to learn more about you. If you align with our core values of integrity, commitment to service, and a supportive workplace culture, we encourage you to consider joining our team. Applications are reviewed by our Corporate Recruitment team.
THANK YOU
We appreciate your interest in this opportunity. We recognize that the job application process can be challenging, and we value the time you invest in applying. For more information about our competitive compensation and comprehensive benefits package, please visit our website.
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