Senior Claims Examiner

Senior Claims Examiner – Athens Administrators

Join to apply for the Senior Claims Examiner role at Athens Administrators
.

Pay range: $49.00/hr – $55.00/hr this range is provided by Athens Administrators. Your actual pay will be based on your skills and experience—talk with your recruiter to learn more.

Position Title:

Senior Claims Examiner
Department:
Workers’ Compensation California

Reports To:

Claims Supervisor
FLSA Status:
Non‑Exempt
Job Grade: 12
Career Ladder:
Next step could include Lead Senior Claims Examiner or Claims Supervisor

Athens Administrators – a family‑owned company since 1976, we foster an inclusive culture and offer continuous professional growth. The position is full‑time and can be located anywhere in the state of California. Employees who live less than 26 miles from the Concord or Orange offices must work once a week in the office Tuesday–Thursday. Remaining days can be remote if technical requirements are met.

The Senior Claims Examiner will adjust workers’ compensation claims from inception to settlement and closure, ensuring timely processing of claims and payment of benefits, managing medical treatment, setting reserves, and negotiating settlements.

• Establish contact with employer to review issues
• Respond to inquiries from employer, employee, doctors, and attorneys
• Establish and maintain appropriate reserves
• Review legal correspondence and medical reports
• Evaluate and approve medical procedures and treatment
• Administer benefits and ensure appropriateness of all payments
• Investigate coverage, liability, and monetary value of claim
• Review medical and legal bills for appropriateness
• Discuss appropriateness of medical treatment with medical case manager
• Determine compensability
• Monitor and assist litigation
• Negotiate settlement of claim, liens, rehabilitation plans, etc.
• Prepare and present reports to clients
• Appropriately close claims
• Help resolve client billing and payment inquiries
• Investigate complaints from injured workers
• Document and code the claim files and claims system with all relevant information
• Maintain and update action plans within specified time frames
• Provide direction to Claims Assistants and Claims Technicians and assist with training, coaching, and mentoring
• Provide customer service and support to clients and claimants
• Work collaboratively with attorneys to draft settlements and assist with litigation strategies
• Authorize and negotiate cost of medical treatment and supplies
• Internal communication with staff
• Prepare professional, well‑written correspondence and other communications

• High School Diploma or equivalent (GED) required;
• AA/AS or BA/BS preferred but not required;
• Administrators Certificate from Self‑Insurance Plans required within one year if not already obtained;
• Current Experienced Indemnity Claims Adjuster Designation;
• 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, procedures;
• Completion of IEA or equivalent courses;
• 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 and multi‑tasking abilities;
• Typing speed: quickly, accurately, for prolonged periods;
• Proficient in Microsoft Office Suite (and willingness to learn additional programs);
• Reasoning, problem‑solving, and analytical skills;
• Trustworthy, dependable, team‑oriented, and innovative;
• Ability to maintain confidentiality of sensitive information;
• Occasional in‑office meetings or file reviews as required.

Submit your résumé and application directly through our website:
Athens Administrators Careers. Feel free to include a cover letter.

Athens Administrators is an Equal Opportunity/Affirmative Action employer. We provide equal employment opportunities to all qualified applicants. We prohibit discrimination in any employment decision.