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

Midwestern Insurance Alliance

<div><div><p>Midwestern Insurance Alliance (MIA) is seeking a full-time California Workers&rsquo; Compensation Assistant to join its workers&rsquo; compensation claims processing team Remotely.</p><p>
MIA is a program administrator offering custom-tailored workers&rsquo; compensation insurance programs through its carrier partners. MIA&rsquo;s acquisition by San Diego-based K2 Insurance Services in 2012 has enabled MIA to expand its product offerings and product distribution channels.</p><p><b>
Pay Range: $29.81&ndash;$31.25 USD/hour</b></p><p>
Workers&rsquo; Compensation Claims Assistant responsibilities include, but are not limited to:</p><ul><li>
Input First Report of Injuries into claims system and related duties at time of receipt.</li><li>
Assist in obtaining police reports on accident claims.</li><li>
Manage incoming faxes and distribute them to the appropriate individual for handling.</li><li>
Handle incoming mail. Prepare and process outgoing mail.</li><li>
Perform as an administrative assistant to the Claims Manager.</li><li>
Upload and index into paperless filing system.</li><li>
Handle claim calls.</li><li>
Provide switchboard relief.</li><li>
Assist in other duties as requested.</li></ul><p>
The ideal Workers&rsquo; Compensation Claims Assistant will have:</p><ul><li>
Some post-high school education.</li><li>
Strong verbal and written communication skills.</li><li>
Strong organizational skills with attention to detail.</li><li>
Ability to work with little supervision.</li><li>
Ability to manage multiple tasks in a fast-paced environment.</li><li>
Proficiency in MS Word, Excel, and Outlook.</li><li>
At least 1 year of California specific administrative or claims support experience.</li></ul><p>
MIA offers the opportunity to join an established company in growth mode. Our benefits package includes medical, dental, vision, disability, and life insurance and 401(k) with employer match. We also offer a business casual work environment and an 8:00-5:00 Monday-Friday work week.</p><p>
Learn more about MIA at midwesterninsurance.com and K2 Insurance Services at k2ins.com.</p></div></div>

California Workers’ Compensation Assistant - REMOTE

FFVA Mutual Insurance

<div><p><i>Assistant Adjuster</i></p><br>
<p></p>
<p>
FFVA Mutual Insurance Company is a mono-line workers&rsquo; compensation carrier, rated A- (Excellent) by A.M. Best. We insure a variety of businesses across ten states and are recruiting for an Assistant Adjuster to join the team in our Maitland, FL office.</p><br>
<p>
</p><p>FFVA Mutual employees enjoy a family-friendly and innovative work environment. We offer competitive compensation and superior benefits.</p><br>
<p></p>
<p>
Essential Functions:</p>
<p>
&sect; Complete state required contacts</p>
<p>
&sect; Make timely indemnity payments</p>
<p>
&sect; Frequent contact with employers, claimants, providers</p>
<p>
&sect; Maintain file diary; keep all files current according to company standards</p>
<p>
&sect; File all required State forms - complete EDI fields</p>
<p>
&sect; Handle files within company and State guidelines</p>
<p>
&sect; Complete all assignments and requests from adjuster</p>
<p>
&sect; Special projects as assigned by management</p>
<p>
&sect; Provide ongoing support to Adjusters on assigned claim files</p><br>
<p></p>
<p><b>
Knowledge &amp; Experience Needed:</b></p>
<p>
&sect; General Workers&rsquo; Compensation claims background not required, but helpful. Florida State claims handling experience preferred, but not needed. Experience in other states in the Southeast a plus.</p>
<p>
&sect; Good communication skills; both oral and written</p>
<p>
&sect; Bilingual English/Spanish a plus</p>
<p>
&sect; Excellent phone etiquette</p>
<p>
&sect; Team player</p>
<p>
&sect; Excellent customer service skills with good rapport building with clients essential</p>
<p>
&sect; Detailed and accurate</p>
<p>
&sect; Ability to multi-task and handle multiple priorities</p></div><p></p>

Assistant Adjuster

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

State of Ohio

<p></p><div><div><p><i>BWC&rsquo;s core hours of operation are Monday-Friday from 8:00am to 5:00pm, however, daily start/end times may vary based on operational need across BWC departments. Most positions perform work on-site at one of BWC&rsquo;s seven offices across the state. BWC offers flex-time work schedules that allow an employee to start the day as early as 7:00am or as late as 8:30am. Flex-time schedules are based on operational need and require supervisor approval.</i></p><p><b>
What our employees have to say:</b><br>
BWC conducts an internal engagement survey on an annual basis. Some comments from our employees include:</p><ul><li>
BWC has been a great place to work as it has provided opportunities for growth that were lacking in my previous place of work.</li><li>
I have worked at several state agencies and BWC is the best place to work.</li><li>
Best place to work in the state and with a sense of family and support.</li><li>
I love the work culture, helpfulness, and acceptance I've been embraced with at BWC.</li><li>
I continue to be impressed with the career longevity of our employees, their level of dedication to service, pride in their work, and vast experience. It really speaks to our mission and why people join BWC and then retire from BWC.</li></ul><p>
If you are interested in helping BWC grow, please</p><p><b>
What You&rsquo;ll Be Doing:</b></p><ul><li><p>
Manages a caseload of Workers&rsquo; Compensation claims: Communicates, coordinates &amp; collaborates with internal &amp; external stakeholders (e.g. Disability Management Coordinator [DMC], Medical Service Specialist [MSS], Managed Care Organization [MCO], Employer Management [EM] team, Safety &amp; Hygiene, injured workers, employers, Third Party Administrators [TPA] &amp; rehabilitation personnel) in order to set return to work expectations.</p></li><li><p>
Performs initial/subsequent claims investigation &amp; determination within prescribed timeframes:<b> </b>Contacts parties involved in claim process; completes investigation during initial claim development to determine information pertinent to management of claim (e.g., jurisdiction, coverage, causality, compensability, claim data accuracy, current work status of claimant, job description, salary continuation, physical demands of job, &amp; work history of claimant).</p></li><li><p>
Processes various types of compensation ranging from Temporary Total (TT) Compensation, Wage Loss, Permanent Partial and Percentage of Permanent Partial, Living Maintenance, to Lump Sum Advancement requests; addresses subsequent requests by parties to claim via due process notification, investigation, BWC orders &amp; referrals to the Industrial Commission (IC) of Ohio</p></li><li><p>
Responds to customer inquiries</p></li><li><p>
Follows Ohio Revised Code and BWC policies and procedures</p></li><li><p>
Communicates with legal representatives, employers, claimants, etc.</p></li></ul><b>
Why Work for the State of Ohio</b><p>
At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:</p>
<ul>
<li>Medical Coverage</li>
<li>Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period</li>
<li>Paid time off, including vacation, personal, sick leave and 11 paid holidays per year</li>
<li>Childbirth, Adoption, and Foster Care leave</li>
<li>Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)</li>
<li>Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) &amp; Optional Deferred Compensation (Ohio Deferred Compensation)</li>
</ul>
<ul><li>Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.</li></ul><b>
Qualifications</b><div>
36 mos. exp. working in private insurance organization as claims representative or equivalent position; successful completion of one typing course or demonstrate ability to type 35 words per minute.
<br>
<br>
<ul><li>Or Completion of undergraduate core coursework in business, humanities, social &amp; behavioral science, education or related field; successful completion of one typing course or demonstrate ability to type 35 words per minute.
</li></ul><br>
-Or 24 mos. exp. as Workers' Compensation Claims Assistant, 16720 (i.e., providing assistance to claims field operations team or medical claims team by ensuring all documents are complete, accurate &amp; in compliance with bureau of workers' compensation procedures, determining allowances using code manual ICD/CPT &amp; taking appropriate action on self- insured claims or referring documents for further action by claims team member, reconstructing lost claim files or assigning claim numbers &amp; updating claim information, &amp; managing caseload of self-insured medical &amp; disability claims to ensure compliance with Ohio Workers' Compensation Law).
<br>
<br>
<ul><li>Or 24 mos. exp. as BWC Customer Service Representative, 64451, (i.e., providing information/assistance to &amp;/or answering complaints, questions &amp;/or telephone inquiries &amp;/or written correspondence from customers pertaining to claims status or procedures, reviewing &amp; analyzing claims, referring customers to available community services, &amp; conducting telephone interviews with citizens reporting fraud allegations) &amp;/or as BWC Employer Service Representative, 63521, (i.e., providing information &amp; assistance &amp;/or responding to complaints, questions &amp; inquiries from customers regarding workers&rsquo; compensation coverage, established binder/applications maintenance, demographics, supplemental &amp; legal entities, manual classifications, debits/credits &amp; payroll reports &amp;/or various BWC programs &amp; research &amp; explain employer refunds, attorney general balances, payments made to policies &amp;/or divided credits).
</li></ul><br>
<ul><li>Or 12 mos. exp. as Workers' Compensation Medical Claims Specialist, 16721 (i.e., managing caseload of medical-only claims &amp; paying medical claims for Ohio Bureau Of Workers' Compensation).
</li></ul><br>
<ul><li>Or any combination of at least 36 mos. exp. working in private insurance organization as claims representative or equivalent position &amp;/or as Workers' Compensation Claims Assistant, 16720 &amp;/or as Workers' Customer Service Representative, 64451 &amp;/or as Workers&rsquo; Compensation Employer Service Representative, 63521.
</li></ul><br>
<ul><li>Or equivalent of Minimum Class Qualifications For Employment noted above. Note: Classification may require use of proficiency demonstration to determine minimum class qualifications for employment.
</li></ul><br>
<b>Job Skills:</b> Claims Examination</div>
<p><b>
Major Worker Characteristics:</b></p>
<p><b>
Knowledge of:</b> workers' compensation laws, policies &amp; procedures*; eligibility criteria &amp; procedures used for processing workers' compensation claims*; English grammar &amp; spelling; oral &amp; written business communication; public relations*; addition, subtraction, multiplication, division, fractions, decimals &amp; percentages; interviewing techniques; internet search engines &amp; navigation; medical terminology; medical diagnosis coding*; Industrial Commission processes*; claims reserving*;
</p><p><b>Skill in:</b> operation of a personal computer; typing; use of Microsoft Office software (e.g., Outlook, Word, Excel, Access, PowerPoint); use of BWC-specific software (e.g., Workers&rsquo; Compensation Claims Management System, Intrafin, FMS fraud system)*; operation of office machinery (e.g. calculator, printer, copier, fax, phone); communication skills (e.g., listening, writing, reading, phone etiquette); use of internet;
</p><p><b>Ability to:</b> define problems, collect data, establish facts, &amp; draw valid conclusions; read &amp; understand medical reference manuals &amp; reports, gather, collate, &amp; classify information about data, people, or things; respond to sensitive inquiries from &amp; contacts with injured workers, employers, providers or their representatives, &amp; the public; answer routine &amp; technical inquiries from injured workers, employers, medical providers &amp; public*; make proper referrals (within agency &amp; external sources)*; diffuse potentially volatile situations; present information to others; work with a team; use International Classification of Diseases (ICD) coding manuals/system*; generate properly formatted business correspondence; read and understand compensation payment plan screens*, interpret Cognos reports*.</p><b>
Supplemental Information</b><p><b>
EEO &amp; ADA Statement:</b><br>
The State of Ohio is an Equal Employment Opportunity Employer and prohibits discrimination and harassment of applicants or employees due to protected classes as defined in applicable federal law, state law, and any effective executive order.</p><p>
The Ohio Bureau of Workers' Compensation is committed to providing access and reasonable accommodation in its employment opportunities pursuant to the Americans with Disabilities Act and other applicable laws. To request reasonable accommodations related to disability, pregnancy, or religion, please contact the ADA mailbox eeodept@bwc.ohio.gov.</p><p><b>
BWC OCSEA Selection Rights:</b><br>
This position shall be filled in accordance with the provisions of the OCSEA Collective Bargaining Agreement. BWC bargaining unit members have selection rights before non-bargaining unit members. All other applications will only be considered if an internal bargaining unit applicant is not selected for this position.</p><p><b>
Salary Information:</b><br>
Hourly wage is expected to be paid at step 1 of the pay range associated with the position for candidates who are new employees of the state. Current employees of the state will be placed in the appropriate step based on any applicable union contract and/or requirements of the Ohio Revised Code. Movement to the next step of the pay range (a roughly 4% increase) will occur after six months, assuming job performance is acceptable. Thereafter, an employee will advance one step in the pay range every year until the highest step of the pay range is reached. There may also be possible cost of living adjustments (COLA) and longevity supplements begin after five (5) years of state service.</p><p><b>
Educational Transcripts:</b><br>
For any educational achievements to be considered during the screening process, you must at least attach an unofficial transcript that details the coursework you have completed.</p><p>
All applicants must submit an Ohio Civil Service Application using the online Ohio Hiring Management System. Paper applications will not be accepted.</p><p><b>
Background Check:</b><br>
Prior to an offer of employment, the final applicant will be required to sign a background check authorization form and undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position.</p><b>
ADA Statement</b><p>
Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.</p><b>
Drug-Free Workplace</b><p>
The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.</p></div></div>

WC Claims Specialist (PN: 20069075 & 20069204)

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>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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