Bilingual Senior Claims Examiner

Bilingual Senior Claims Examiner - Southern CaliforniaAthens Administrators has an immediate need for a full-time Workers' Compensation Senior Claims Examiner that is fluent in Spanish. This position is full-time remote, unless you live less than 26 miles from the Orange, CA office on The City Drive, then it would be hybrid once a week. The position is Monday through Friday, 7.5 hours a day with the option of a flex schedule getting every third Friday or Monday off.The Senior Claims Examiner will adjust workers' compensation claims for a healthcare account 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.PRIMARY RESPONSIBILITIESOur 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 issuesRespond to inquiries from the employer, employee, doctors, and attorneysEstablish and maintain appropriate reservesReview legal correspondence and medical reportsEvaluate and approve medical procedures and treatmentAdminister benefits and ensure appropriateness of all paymentsInvestigate coverage, liability, and monetary value of claimReview medical and legal bills for appropriatenessDiscuss appropriateness of medical treatment with medical case managerDetermine compensabilityMonitor and assist litigationNegotiate settlement of claim, liens, rehabilitation plans, etc.Prepare and present reports to clientsAppropriately close claimsHelp resolve client billing and payment inquiriesInvestigate complaints from injured workersDocument and code the claim files and claims system with all relevant informationMaintain and update action plans within specified time framesProvide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring as needed for them to support daily claims tasksContact with employers, employees, attorneys, doctors, vendors, and other partiesProvide customer service and support to clients and claimantsWork collaboratively with attorneys to draft settlements and assist with litigation strategiesNegotiate settlementsAuthorize and negotiate cost of medical treatment and suppliesInternal communication with staffPrepare professional, well written correspondence and other communicationsESSENTIAL 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.Spanish Fluency requriedHigh School Diploma or equivalent (GED) required for all positions. AA/AS or BA/BS preferred but not requiredAdministrators Certificate from Self-Insurance Plans will be required within one year of employment if not already obtainedMust 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 requiredAt least 5 years of workers compensation claims experience preferredSolid knowledge of workers compensation laws, policies, and procedures'Completion of IEA or equivalent coursesProficiency in determining case value and negotiating settlementsUnderstanding of medical and legal terminologyMathematical calculating skillsWell-developed verbal and written communication skills with strong attention to detailExcellent organizational skills and ability to multi-taskAbility to type quickly, accurately and for prolonged periodsProficient in Microsoft Office Suite. Ability to learn additional computer programsReasoning 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 resolutionAbility to be trustworthy, dependable, and team-oriented for fellow employees and the organizationSeeks to include innovative strategies and methods to provide a high level of commitment to service and resultsAbility to demonstrate care and concern for fellow team members and clients in a professional and friendly mannerActs 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 positionAPPLY WITH USWe look forward to learning about YOU! If you believe in our core values of honesty and integrity, a commitment to service and results, and a caring family culture, we invite you to apply with us. 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 Recruitment team. The Company will consider qualified applicants with arrest or conviction records in accordance with the Los Angeles Fair Chance Ordinance for Employers and the California Fair Chance Act. Applicants can learn more about the Los Angeles County Fair Chance Act, including their rights, by clicking on the following link: 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.THANK YOU!We look forward to reviewing your information. We understand that applying for jobs may not be the most enjoyable task, so we genuinely appreciate the time you've dedicated. Don't forget to check out our website at as well as our LinkedInGlassdoor, and Facebook pages!Athens Administrators is dedicated to fair and equitable compensation for our employees that is both competitive and reflective of the market. The estimated rate of pay can vary depending on skills, knowledge, abilities, location, labor market trends, experience, education including applicable licenses & certifications, etc. Our ranges may be modified at any time. In addition, eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments. We offer a variety of benefit plans including 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 and more! Further information about our comprehensive benefits package may be found on our website at

Created: 2025-02-14