claims assistant

AllCare Management Services

<div><p><b>We Are Seeking Qualified Candidates to Join Our Team!</b></p><p>
AllCare Health offers competitive wages, an excellent benefits package including affordable healthcare, 401k retirement, wellness programs, and flexible schedule options.</p><b>
Summary of the Position</b><p>
This position supports claims operations and financial integrity by performing a variety of administrative and department functions related to claims processing, system COB updates, and audit support. Responsibilities include managing Coordination of Benefits (COB) reporting, implementing updates within the EZ-CAP claims system, processing refunds and overpayment recoveries, and assisting with internal and external audit activities, including HSAG, OHA, CMS, and financial audits. The role also involves reviewing claims identified through monitoring reports, ensuring issues are researched and resolved appropriately, and supporting check run activities to help ensure accurate and timely provider payments. This position works collaboratively with all claims staff, finance, compliance, and IT teams to maintain efficient operations and ensure adherence to regulatory and organizational requirements.</p><b>
Essential Duties</b><br>
1. Maintain and update Coordination of Benefits (COB) information, including reporting, verification, and system updates to ensure accurate claims processing<br>
2. Review, research, and process refund requests and overpayment recoveries, ensuring compliance with contractual, regulatory, and internal policies<br>
3. Provide departmental support for internal and external audits, including preparation of documentation and data requests for entities such as HSAG, CMS, and financial auditors<br>
<br>
<b>Qualifications</b><p>
Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.</p><b>
Education</b><p>
High school diploma or general education degree (GED) required. College degree in an applicable field is preferred.</p><p><b>
Experience</b></p><p>
One to two years related experience and/or training in administrative and/or medical claims processing required. EZ-CAP claim processing system experience is highly preferred.</p><b>
Certificates, Licenses, and/or Registrations</b><br>
This position does not require any certificates, licenses, or registrations. The following certifications are preferred for this job role:<br>
<ul><li>Certified Professional Coder (CPC)</li><li><br>
Certified Clinical Medical Assistant (CCMA)</li><li>Certified Billing and Coding Specialist (CBCS)</li><li>Certified Medical Administrative Assistant (CMAA)</li><li>Certified Coding Specialist (CCS)</li></ul><br>
<b>
Technical Skills</b><br>
<ul><li>Knowledge of and compliance with HIPAA regulations.</li><li>Proficient in data entry and use of claims management systems</li><li>Knowledge of Medicare and Medicaid, procedures, and regulatory requirements</li><li>Basic understanding of medical coding and billing practices</li><li>Strong attention to detail and ability to identify discrepancies or inconsistencies</li><li>Excellent organizational skills and ability to manage multiple tasks efficiently</li><li>Excellent communication skills, both written and verbal, for interaction with internal and external stakeholders</li><li>Exceptional writing, editing, and proofreading skills.</li><li>Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).</li><li>Skilled at breaking a project into definable and measurable tasks and tracking progress to completion.</li><li>Excellent customer service skills to respond appropriately and interact positively with upset customers.</li></ul><b>
Interpersonal Skills</b><ul><li>Reliable, confident, and effective in fostering positive relationships.</li><li>Demonstrates accountability, inspires trust, and connects well with colleagues.</li><li>Trustworthy, accountable, and skilled at collaborative engagement.</li></ul><b>
Language Skills</b><br>
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.<br>
<br>
<b>Mathematical Skills</b><p>
Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume. Ability to apply concepts of basic algebra and geometry.</p><b>
Computer Skills</b><p>
Has advanced basic computer job skills including logging on to systems, ability to communicate by email, ability to compose documents, enter database information, create presentations, download forms, and preserve/backup important data.</p><p><b>
Reasoning Ability</b></p><p>
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to work with problems involving a few concrete variables in standardized situations.</p><p><b>
Physical Demands &amp; Work Environment</b></p><p>
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties of this job. The work environment characteristics described here are representative of those an employee encounters while performing the essential duties of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.</p>
The employee must occasionally lift and/or move up to 10 pounds. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The noise level in the work environment is usually moderate.<br>
<br>
<ul><li>The employee must be able to work onsite, as needed.</li><li>The employee can work from a home office, occasionally.</li></ul><p></p><p><b><br>
Company Overview</b></p><p>
AllCare Health Website: https://www.allcarehealth.com.</p><p>
AllCare Health is incorporated as an Oregon Benefit Corporation and has earned the coveted Certified B Corp&reg; status since 2017. As such, AllCare Health considers its impact on community, society, and the environment in all business decisions. We have long recognized the value in social, economic, and environmental concerns of our employees, customers, and community members. (Learn more about B Corps at https://bcorporation.net/about-b-corps)</p><p>
AllCare Health headquarters are located in Grants Pass in Southern Oregon on the Rogue River, surrounded by mountains, forests, small farms, and breathtaking views. This thriving and energetic community is ideal for families and outdoor enthusiasts, with a temperate Pacific Northwest climate. We enjoy easy access to outdoor sports and recreation, river rafting, fishing, hiking, biking, wineries, outdoor concerts, the world-famous Ashland Shakespeare Festival, the stunning Oregon coast, magnificent redwood forests, pristine beaches, and much more.</p><p><b>
The AllCare Health family of businesses is guided by our corporate principles:</b></p><p><b>
Purpose</b> | Working together with our communities to improve the health and well-being of everyone.</p><p><b>
Values</b> | Trust, Innovation, Relationships, and Voice.</p><p><b>
Vision</b> | Thriving, Inclusive, and Equitable communities.</p><p><b>
Brand Promise</b> | Changing Healthcare to Work for You.</p><p>
AllCare Health is dedicated to building a diverse and authentic workplace centered in belonging and serving our growing community. If you are excited about this open position but your experience does not align perfectly with every qualification in this post, we encourage you to apply anyway or reach out to our human resources department. You may just be the right candidate for this role or others.</p><p>
If you need accommodations, help in the application process, or wish to receive this job announcement in an alternative format, please call 541-471-4106 and ask for Human Resources.</p><p>
All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.</p><p></p><p><br>
699 - Claims Processing Assistant_March2026.pdf</p></div>

CLAIMS PROCESSING ASSISTANT

Athens Administrators

<div><div><b>ATHENS POSITION DETAILS</b></div>
<div></div><div><div><div><div><div><b>Position Title:</b></div>
</div><div><div>Assistant Claims Examiner</div><br>
</div></div><br>
<div><div><div><b>Department:</b></div>
</div><div><div>Workers&rsquo; Compensation</div><br>
</div></div><br>
<div><div><div><b>Reports To:</b></div>
</div><div><div>Claims Supervisor</div><br>
</div></div><br>
<div><div><div><b>FLSA Status:</b></div>
</div><div><div>Non-Exempt</div><br>
</div></div><br>
<div><div><div><b>Job Grade:</b></div>
</div><div><div>6</div><br>
</div></div><br>
<div><div><div><b>Career Ladder:
</b></div></div><div><div>Next step in progression could include Future Medical Examiner or Claims Examiner Trainee</div>
</div></div><br>
</div></div><div></div><div><b>ATHENS ADMINISTRATORS</b></div>
<div>Explore the Athens Administrators difference: 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 &ldquo;Best Place to Work.&rdquo; Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property &amp; Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today!</div>
<div></div><div><b>POSITION SUMMARY</b></div>
<div>Athens Administrators has an immediate need for an experienced Assistant Claims Examiner to support our Workers&rsquo; Compensation department and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday &ndash; Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. 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 Assistant Claims Examiner will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves.</div>
<div></div><div><b>PRIMARY RESPONSIBILITIES</b></div>
<div>Our 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:</div>
<div></div><ul><li>Process new claims in compliance with client&rsquo;s Service Agreement</li>
<li>Issue all indemnity payments and awards on time</li>
<li>Process all approved provider bills timely</li>
<li>Prepare objection letters to providers for medical bills; delayed, denied, lacking reports.</li>
<li>Answer questions over the phone from medical providers regarding bills</li>
<li>Contact treating physician for disability status</li>
<li>Contact employer for return-to-work status or availability of modified work.</li>
<li>Contact injured worker at initial set up</li>
<li>Send DWC notices timely</li>
<li>Issue SJDB Notices timely</li>
<li>Request Job Description from Employer</li>
<li>Handle Medical Only claim files</li>
<li>Calculate wage statements and adjust disability rates as required</li>
<li>Keep diary for all delay dates and indemnity payments</li>
<li>Documents file activity on computer</li>
<li>Update information on computer, i.e., address changes, etc.</li>
<li>Schedule appointments for AME, QME evaluations</li>
<li>Send appointment letters, issue TD/mileage, send medical file</li>
<li>Schedule interpreter for appointments, depositions, etc.</li>
<li>Request Employer&rsquo;s Report, DWC-1, Doctor&rsquo;s First Report if needed</li>
<li>Verify mileage and dates of treatment for reimbursement to claimant</li>
<li>Subpoena records</li>
<li>File and serve documents on attorneys, WCAB, doctors</li>
<li>Serve PTP&rsquo;s with medical file and Duties of Treating Physician (9785)</li>
<li>Request PD ratings from DEU</li>
<li>Draft Stipulated Awards and C&amp;R&rsquo;s</li>
<li>Submit C&amp;R, Stipulated Awards to WCAB for approval with documentation</li>
<li>Process checks &ndash; stop payment, cancellations, void, journal payments</li>
<li>Handle telephone calls for examiner as needed</li>
<li>Complete penalty calculations and prepare penalty worksheets</li>
<li>Complete MPN, HCO and/or EDI coding</li>
<li>Complete referrals to investigators</li>
<li>Complete preparation of documents for overnight delivery</li>
<li>Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners</li>
<li>Contact with clients, injured workers, attorneys, doctors, vendors, and other parties</li>
<li>Provide updates of claims status to Senior Claims Examiners and Athens management</li>
<li>Prepare professional, well written correspondence and other communications</li>
</ul>
<div></div><div><b>ESSENTIAL POSITION REQUIREMENTS
</b></div><div>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.</div>
<ul><li>High School Diploma or equivalent (GED) required for all positions
<ul><li>AA/AS or BA/BS preferred but not required</li>
</ul></li><li>2+ years&rsquo; Claims Assistant experience supporting a workers compensation examiner or team preferred</li>
<li>Medical Only Adjuster designation required</li>
<li>Continuing hours must be current</li>
<li>Mathematical calculating skills</li>
<li>Completion of IEA or equivalent courses</li>
<li>Administrators Certificate from Self-Insurance Plans preferred</li>
<li>Knowledge of workers compensation laws, policies, and procedures</li>
<li>Understanding of medical and legal terminology</li>
<li>Must demonstrate accuracy and thoroughness in work product</li>
<li>Ability to sit for prolonged periods of time</li>
<li>Well-developed verbal and written communication skills with strong attention to detail</li>
<li>Excellent organizational skills and ability to multi-task</li>
<li>Ability to type quickly, accurately and for prolonged periods</li>
<li>Proficient in Microsoft Office Suite</li>
<li>Ability to learn additional computer programs</li>
<li>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</li>
<li>Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization</li>
<li>Seeks to include innovative strategies and methods to provide a high level of commitment to service and results</li>
<li>Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner</li>
<li>Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor</li>
<li>Athens&rsquo; 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.</li>
<li>Must be able to reliably commute to meetings and events as required by this position</li>
</ul><div><b>APPLY WITH US</b></div>
<div>We 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 http://www.athensadmin.com/careers/job-openings Feel free to include a cover letter if you&rsquo;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: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf</div>
<div></div><div>This 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.</div>
<div></div><div>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.</div>
<div></div><div><b>THANK YOU!</b></div>
<div>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&rsquo;t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!</div>
<div></div><div>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 &amp; 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&amp;D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA &amp; FSA options, 401k (and Roth), Company-Paid STD &amp; LTD and more! Further information about our comprehensive benefits package may be found on our website at <b>https://www.athensadmin.com/careers/why-work-here</b></div></div>

Assistant Claims Examiner

<div>
 ATHENS POSITION DETAILS
 <br/>
 <br/>
 <strong>
  Position Title:
  <br/>
  <br/>
 </strong>
 Assistant Claims Examiner - Flex
 <br/>
 <br/>
 <strong>
  Department:
  <br/>
  <br/>
 </strong>
 Workers&rsquo; Compensation
 <br/>
 <br/>
 <strong>
  Reports To:
  <br/>
  <br/>
 </strong>
 Claims Supervisor
 <br/>
 <br/>
 <strong>
  FLSA Status:
  <br/>
  <br/>
 </strong>
 Non-Exempt
 <br/>
 <br/>
 <strong>
  Job Grade:
  <br/>
  <br/>
 </strong>
 6
 <br/>
 <br/>
 <strong>
  Career Ladder:
  <br/>
  <br/>
 </strong>
 Next step in progression could include Future Medical Examiner or Claims Examiner Trainee
 <br/>
 <br/>
 <strong>
  ATHENS ADMINISTRATORS
  <br/>
  <br/>
 </strong>
 Explore the Athens Administrators difference: 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 &ldquo;Best Place to Work.&rdquo; Immerse yourself in our engaging, supportive, and inclusive culture, offering opportunities for continuous professional growth. Join our nationwide family-owned company in Workers' Compensation, Property &amp; Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today!
 <br/>
 <br/>
 <strong>
  Position Summary
  <br/>
  <br/>
 </strong>
 Athens Administrators has an immediate need for an experienced Assistant Claims Examiner - Flex to support our Workers&rsquo; Compensation department and can be located anywhere in the state of California, however, employees who live less than 26 miles from the Concord, CA or Orange, CA offices are required to work once a week in the office on a day determined by their supervisor between Tuesday &ndash; Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in California. 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.
 <br/>
 <br/>
 The Assistant Claims Examiner - Flex will provide clerical and technical assistance to Senior Claims Examiners and administer Medical Only claims, ensuring timely processing of claims and payment of benefits, managing, and directing medical treatment, and setting reserves for a variety of teams and clients at Athens.
 <br/>
 <br/>
 <strong>
  Primary Responsibilities
  <br/>
  <br/>
 </strong>
 Our 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:
 <br/>
 <br/>
 <ul>
  <li>
   Process new claims in compliance with client&rsquo;s Service Agreement
  </li>
  <li>
   Issue all indemnity payments and awards on time
  </li>
  <li>
   Process all approved provider bills timely
  </li>
  <li>
   Prepare objection letters to providers for medical bills; delayed, denied, lacking reports.
  </li>
  <li>
   Answer questions over the phone from medical providers regarding bills
  </li>
  <li>
   Contact treating physician for disability status
  </li>
  <li>
   Contact employer for return-to-work status or availability of modified work.
  </li>
  <li>
   Contact injured worker at initial set up
  </li>
  <li>
   Send DWC notices timely
  </li>
  <li>
   Issue SJDB Notices timely
  </li>
  <li>
   Request Job Description from Employer
  </li>
  <li>
   Handle Medical Only claim files
  </li>
  <li>
   Calculate wage statements and adjust disability rates as required
  </li>
  <li>
   Keep diary for all delay dates and indemnity payments
  </li>
  <li>
   Documents file activity on computer
  </li>
  <li>
   Update information on computer, i.e., address changes, etc.
  </li>
  <li>
   Schedule appointments for AME, QME evaluations
  </li>
  <li>
   Send appointment letters, issue TD/mileage, send medical file
  </li>
  <li>
   Schedule interpreter for appointments, depositions, etc.
  </li>
  <li>
   Request Employer&rsquo;s Report, DWC-1, Doctor&rsquo;s First Report if needed
  </li>
  <li>
   Verify mileage and dates of treatment for reimbursement to claimant
  </li>
  <li>
   Subpoena records
  </li>
  <li>
   File and serve documents on attorneys, WCAB, doctors
  </li>
  <li>
   Serve PTP&rsquo;s with medical file and Duties of Treating Physician (9785)
  </li>
  <li>
   Request PD ratings from DEU
  </li>
  <li>
   Draft Stipulated Awards and C&amp;R&rsquo;s
  </li>
  <li>
   Submit C&amp;R, Stipulated Awards to WCAB for approval with documentation
  </li>
  <li>
   Process checks &ndash; stop payment, cancellations, void, journal payments
  </li>
  <li>
   Handle telephone calls for examiner as needed
  </li>
  <li>
   Complete penalty calculations and prepare penalty worksheets
  </li>
  <li>
   Complete MPN, HCO and/or EDI coding
  </li>
  <li>
   Complete referrals to investigators
  </li>
  <li>
   Complete preparation of documents for overnight delivery
  </li>
  <li>
   Work collaboratively with Senior Claims Examiners, Nurse Case Managers, and other Assistant Claims Examiners
  </li>
  <li>
   Contact with clients, injured workers, attorneys, doctors, vendors, and other parties
  </li>
  <li>
   Provide updates of claims status to Senior Claims Examiners and Athens management
  </li>
  <li>
   Prepare professional, well written correspondence and other communications
   <br/>
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Essential Position Requirements
  <br/>
  <br/>
 </strong>
 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.
 <br/>
 <br/>
 <ul>
  <li>
   High School Diploma or equivalent (GED) required for all positions
  </li>
  <ul>
   <li>
    AA/AS or BA/BS preferred but not required
   </li>
  </ul>
  <li>
   2+ years&rsquo; Claims Assistant experience supporting a workers compensation examiner or team preferred
  </li>
  <li>
   Medical Only Adjuster designation required
  </li>
  <li>
   Continuing hours must be current
  </li>
  <li>
   Mathematical calculating skills
  </li>
  <li>
   Completion of IEA or equivalent courses
  </li>
  <li>
   Administrators Certificate from Self-Insurance Plans preferred
  </li>
  <li>
   Knowledge of workers compensation laws, policies, and procedures
  </li>
  <li>
   Understanding of medical and legal terminology
  </li>
  <li>
   Must demonstrate accuracy and thoroughness in work product
  </li>
  <li>
   Ability to sit for prolonged periods of time
  </li>
  <li>
   Well-developed verbal and written communication skills with strong attention to detail
  </li>
  <li>
   Excellent organizational skills and ability to multi-task
  </li>
  <li>
   Ability to type quickly, accurately and for prolonged periods
  </li>
  <li>
   Proficient in Microsoft Office Suite
  </li>
  <li>
   Ability to learn additional computer programs
  </li>
  <li>
   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
  </li>
  <li>
   Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization
  </li>
  <li>
   Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
  </li>
  <li>
   Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner
  </li>
  <li>
   Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor
  </li>
  <li>
   Athens&rsquo; 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.
  </li>
  <li>
   Must be able to reliably commute to meetings and events as required by this position
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  APPLY WITH US
  <br/>
  <br/>
 </strong>
 We 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 http://www.athensadmin.com/careers/job-openings Feel free to include a cover letter if you&rsquo;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: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf
 <br/>
 <br/>
 This 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.
 <br/>
 <br/>
 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.
 <br/>
 <br/>
 <strong>
  THANK YOU!
  <br/>
  <br/>
 </strong>
 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&rsquo;t forget to check out our website at www.athensadmin.com as well as our LinkedIn, Glassdoor, and Facebook pages!
 <br/>
 <br/>
 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 &amp; 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&amp;D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA &amp; FSA options, 401k (and Roth), Company-Paid STD &amp; LTD and more! Further information about our comprehensive benefits package may be found on our website at
 <strong>
  https://www.athensadmin.com/careers/why-work-here
 </strong>
</div>


Assistant Claims Examiner - Remote or Hybrid in CA

Venture General Agency

<p><b>Job Summary</b><br/>We are seeking a detail-oriented and organized person to work in an office setting. No prior experience necessary but office experience a big plus. We do all the ON THE JOB TRAINING! No nights or weekends!</p><p><b>Responsibilities</b></p><ul><li>Answering inbound phone calls and making outbound calls.</li><li>Ordering police report.</li><li>Running vehicle registration</li><li>Helping on general investigation</li><li>Communicate effectively with team members.</li><li>Assist claims management with general claim support task.</li></ul><p><b>Experience</b></p><ul><li>Spanish fluency a must</li><li>Typing - must be able to use a keyboard</li><li>Customer service experience</li><li>Strong organizational skills with attention to detail are required.</li><li>Dependability - must be at work every scheduled day</li></ul><p>If you are a dependable person who is willing to learn and work hard in a customer service environment in an office setting, we encourage you to apply for the Claims Assistant position.</p><p>Job Type: Full-time</p><p>Benefits:</p><ul><li>Health insurance</li><li>Paid time off</li></ul><p>Work Location: In person</p>

Customer Service Representative - CLAIMS DEPARTMENT

HolleyFirm LLC

<p><b>Job Summary</b><br/>We are seeking a detail-oriented and proactive Liens &amp; Subrogation Assistant to join our dynamic team. In this vital role, you will support the resolution of insurance claims by managing lien processes and subrogation efforts efficiently. Your expertise in accounting principles, medical billing, and financial software will help ensure accurate tracking of claims, proper documentation, and effective negotiations with third parties. This position offers an exciting opportunity to contribute to the financial health of our organization while developing your skills in healthcare reimbursement, legal processes, and financial analysis.</p><p><b>Responsibilities</b></p><ul><li>Assist in managing lien filings and releases related to insurance claims, ensuring compliance with applicable regulations and policies.</li><li>Support subrogation activities by identifying recoverable amounts, initiating collection efforts, and tracking recovery progress.</li><li>Enter and maintain accurate data within various accounting software systems such as QuickBooks, Sage, PeopleSoft, and other financial tools.</li><li>Conduct account reconciliation to verify the accuracy of receivables, payables, and related financial transactions.</li><li>Collaborate with medical billing teams.</li><li>Analyze accounts receivable data to identify discrepancies, trends, or issues requiring further investigation or negotiation.</li><li>Prepare detailed reports on lien status, subrogation cases, and recovery outcomes for management review.</li><li>Engage in negotiation with third-party payers or legal entities to facilitate claim resolution while maintaining professional phone etiquette and customer service standards.</li></ul><p><b>Qualifications</b></p><ul><li>Strong understanding of GAAP (Generally Accepted Accounting Principles), corporate accounting practices, and governmental accounting standards.</li><li>Knowledge of medical terminology and medical billing procedures is highly desirable.</li><li>Demonstrated ability to perform data entry accurately using 10 key typing skills and double-entry bookkeeping methods.</li><li>Experience with accounts receivable/payable processes, account reconciliation, journal entries, and revenue cycle management.</li><li>Excellent analysis skills with attention to detail for account analysis and financial concept application.</li><li>Effective negotiation skills combined with professional phone etiquette for engaging with clients or third-party payers.</li><li>Familiarity with legal aspects of liens and subrogation processes within the healthcare or insurance industry is preferred.</li><li>Strong organizational skills with the ability to manage multiple cases simultaneously while adhering to deadlines. Join us in a role that combines technical accounting expertise with impactful healthcare reimbursement work! We&rsquo;re committed to fostering a collaborative environment where your skills grow alongside our mission to deliver exceptional service in the financial services sector related to healthcare claims management.</li></ul><p>Pay: $24.72 - $29.77 per hour</p><p>Benefits:</p><ul><li>Paid time off</li><li>Tuition reimbursement</li><li>Work from home</li></ul><p>Work Location: Hybrid remote in Cincinnati, OH 45219</p>

Liens & Subrogation Assistant

Sedgwick

<div><p>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
</p><p></p><p>Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
</p><p>Certified as a Great Place to Work&reg;
</p><p>Fortune Best Workplaces in Financial Services &amp; Insurance
</p><p></p>Workers Compensation Assistant Claims Manager | Dedicated Account
<div><p>Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world&rsquo;s best brands?
</p><ul><li>Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
</li><li>Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world&rsquo;s most respected organizations.
</li><li>Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
</li><li>Leverage Sedgwick&rsquo;s broad, global network of experts to both learn from and to share your insights.
</li><li>Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
</li><li>Enjoy flexibility and autonomy in your daily work, your location, and your career path.
</li><li>Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
</li></ul><p></p><p><b>ARE YOU AN IDEAL CANDIDATE? </b>We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
</p><p></p><p><b>OFFICE LOCATIONS
</b><br>
Brea, CA
</p><p></p><p><b>PRIMARY PURPOSE OF THE ROLE: </b>Oversees technical and operational functions, ensuring compliance with company standards and industry best practices; consistent delivery of high‑quality services; effective staffing, training, and budget management, including profit and loss responsibility. Has direct and/or indirect responsibility for up to 25 colleagues.
</p><p></p><p><b>ESSENTIAL RESPONSIBLITIES MAY INCLUDE
</b></p><ul><li>Oversees internal quality review processes, supports organizational quality programs, and reports results monthly.
</li><li>Ensures compliance with client internal controls, audit requirements, service agreements, company policies, state regulations, plan documents, and industry best practices.
</li><li>Develops and executes business plans with goals and objectives for assigned clients; establishes and maintains client relationships.
</li><li>Administers personnel policies, staffing standards, and training recommendations; assists with interviewing, hiring, performance development plans, and conducts performance discussions.
</li><li>Provides leadership, guidance, and motivation to promote high performance.
</li><li>Travels as required and performs other duties as assigned.
</li></ul><p></p><p><b>QUALIFICATIONS
</b></p><p>Education &amp; Licensing: 8 years of claims management experience or equivalent combination of experience and education required to include 1 year supervisory experience.
</p><ul><li>Bachelor's degree from an accredited college or university preferred.
</li><li>Professional certification as applicable to line of business preferred.
</li></ul><p></p><p><b>Licensing / Jurisdiction Knowledge: California workers' compensation claims experience required | SIP preferred
</b></p><p></p><p><b>TAKING CARE OF YOU
</b></p><ul><li>Flexible work schedule.
</li><li>Referral incentive program.
</li><li>Career development and promotional growth opportunities.
</li><li>A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
</li></ul><p></p><p>As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $110,000-$118,000/yr. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
</p><p></p><p>#LI-GC1 #hybrid #claims
</p></div><p></p><p>Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles&rsquo; Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
</p><p></p><p>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
</p><p></p><h2 class="jobSectionHeader"><b>If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</b></h2></div>

Workers Compensation Assistant Claims Manager | Dedicated Account

<div><p>By joining Sedgwick, you'll be part of something truly meaningful. It&rsquo;s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there&rsquo;s no limit to what you can achieve.
</p><p></p><p>Newsweek Recognizes Sedgwick as America&rsquo;s Greatest Workplaces National Top Companies
</p><p>Certified as a Great Place to Work&reg;
</p><p>Fortune Best Workplaces in Financial Services &amp; Insurance
</p><p></p>Claims Associate - Workers Compensation
<p></p><p><b>Our teams connect! We collaborate onsite and have a hybrid work arrangement. All candidates must live near one of our centers of excellence:
</b></p><p></p><p><b>Southfield, MI </b>: 300 Galleria Officentre Southfield MI 48034
</p><p></p><p><b>PRIMARY PURPOSE </b>: To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.
</p><p><b>ESSENTIAL FUNCTIONS and RESPONSIBILITIES
</b></p><ul><li>Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision.
</li><li>Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
</li><li>Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency.
</li><li>Communicates claim action/processing with claimant, client and appropriate medical contact.
</li><li>Ensures claim files are properly documented and claims coding is correct.
</li><li>May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.
</li><li>Maintains professional client relationships.
</li></ul><p><b>ADDITIONAL FUNCTIONS and RESPONSIBILITIES
</b></p><ul><li>Performs other duties as assigned.
</li><li>Supports the organization's quality program(s).
</li></ul><p><b>QUALIFICATION
</b></p><p><b>Education &amp; Licensing
</b><br>
High school diploma or GED required. Licenses as required.
</p><p><b>Experience
</b><br>
One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.
</p><p><b>Skills &amp; Knowledge
</b></p><ul><li>Excellent oral and written communication skills
</li><li>PC literate, including Microsoft Office products
</li><li>Analytical and interpretive skills
</li><li>Strong organizational skills
</li><li>Good interpersonal skills
</li><li>Ability to work in a team environment
</li><li>Ability to meet or exceed Performance Competencies
</li></ul><p><b>WORK ENVIRONMENT
</b><br>
When applicable and appropriate, consideration will be given to reasonable accommodations.
</p><p><b>Mental: </b>Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
</p><p><b>Physical: </b>Computer keyboarding, travel as required
</p><p><b>Auditory/Visual: </b>Hearing, vision and talking
</p><p></p><p>The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
</p><p></p><p>Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
</p><p></p><h2 class="jobSectionHeader"><b>If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.</b></h2></div>

Claims Associate - Workers Compensation

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