We have been dynamic, innovative leaders in claims administration since our founding in 1976. We foster an environment where employees not only thrive but consistently recognize Athens as a “Best Place to Work.” Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth.
Senior Claims Examiner
Location
United States
Posted
36 days ago
Salary
0
Seniority
Senior
No structured requirement data.
Job Description
Senior Claims Examiner
Athens Administrators
Role Description Athens Administrators has an immediate need for a full-time Senior Claims Examiner to support our workers compensation department. Employees who live less than 26 miles from the San Antonio, TX office are required to work once a week in the office on a day determined by their supervisor between Tuesday – Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in Texas. 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. Qualifications - High School Diploma or equivalent (GED) required for all positions - AA/AS or BA/BS preferred but not required - The Texas 03 Workers’ Compensation license is required - The 08 All Lines License is preferred - 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 - 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 - Reasoning ability, including problem-solving and analytical skills - Ability to be trustworthy, dependable, and team-oriented - 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 - Acts with integrity in difficult or challenging situations Requirements - Must be able to reliably commute to meetings and events as required by this position - Athens’ operations involve handling confidential, proprietary, and highly sensitive information Benefits - Medical, Vision, Dental, Life and AD&D insurance - Long Term Care, Critical Care, Accidental, Hospital Indemnity - HSA & FSA options - 401k (and Roth) - Company-Paid STD & LTD - Eligible employees may be considered annually for discretionary salary adjustments and/or incentive payments
Related Guides
Related Categories
Related Job Pages
More Claims Specialist Jobs
• Prepare mortgage insurance claims on assigned agency or investor-acquired properties. • Complete reconciliation of all advances to be included in the claim. • Validate all the necessary supporting documents needed for the claim. • Maintain clear records and reports for management regarding daily production. • Assist with updating appropriate workstations for claim payments. • Follow up and track payment of filed claims. • Conduct miscellaneous research to complete daily tasks. • Complete tasks queue and notate internal system accordingly • All other duties as assigned.
• Examine, review and process claims according to contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards • Assess appropriateness of returned, denied, or paid claims by reviewing and following contractual obligations, federal and state regulations, organizational policies and procedures, or other established quality standards • Ensure claim timeliness processing standards are being met • Work alongside manager to establish and maintain claims processing rules that meet all regulatory and business requirements • Assist internal and external partners with questions related to claims decisions or claims statuses • Maintain a comprehensive understanding of claim processing guidelines at both the federal and state level
• Analyzes and processes complex or technically difficult general liability and litigated claims by investigating and gathering information to determine the exposure on the claim. • Manages claims through well-developed action plans to an appropriate and timely resolution. • Assesses liability and resolves claims within evaluation. • Negotiates settlement of claims within designated authority. • Calculates and assigns timely and appropriate reserves to claims.
• Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; • manages claims through well-developed action plans to an appropriate and timely resolution. • Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions. • Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life. • Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement. • Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines. • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients. • Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost. • Represents Company in depositions, mediations, and trial monitoring as needed. • Communicates claim activity and processing with the client; maintains professional client relationships. • Ensures claim files are properly documented and claims coding is correct. • Refers cases as appropriate to supervisor and management. • Performs other duties as assigned. • Supports the organization's quality program(s).


