corporate claims examiner

State of Utah

<p></p><div><p><b>Claims Examiner I, Career Service Exempt</b></p><p><b>
FT / PT Status &ndash; </b>Full-Time<br>
<b>Salary &ndash; </b>$18.00 - $31.61 Hourly Wage
<br>
<b>Remote Work / In-Office &ndash; </b>Hybrid (After ample training, may qualify for hybrid/remote)<br>
<br>
<b>Recruiter &ndash; </b>Liz Vander Linden | evander@utah.gov | 801-957-7232<br>
<b>Application Deadline &ndash; </b>4/26/2026</p><p></p><p><b><br>
Key Responsibilities</b></p><p><br>
The Utah Unclaimed Property Division seeks a full-time Claims Examiner I, Career Service Exempt to join our committed, creative, and enthusiastic team. We return tens of millions of dollars of unclaimed property to rightful owners every year.<br>
Our next Claims Examiner I will assist many Utahns in recovering their lost money. Some claims are very easy and others are like solving a huge puzzle to determine who is the rightful owner. Look us up at: mycash.utah.gov.</p><p>
Please note this is an entry level position.</p><p>
Do you:</p><ul><li>
Strive for accuracy and precision?</li><li>
Perform best with clear direction, rules, and structure?</li><li>
Enjoy being a resource of knowledge &amp; information for others?</li><li>
Embrace opportunities to work independently?</li><li>
Relish Solving problems and pivoting to meet the current need?</li><li>
Avoid chaos and drama and instead focus on facts and data?</li><li>
Prefer to work alone on tasks rather than in a group?</li><li>
Are you a skeptical person who requires volumes of information before forming a firm opinion?</li><li>
Find that your communication style is more informative and factual than socially oriented?</li><li>
Possess a natural sense of urgency &amp; move quickly between tasks?</li><li>
Communicate directly, factually &amp; in a no-nonsense manner?</li><li>
Desire change, new challenges, &amp; variety over routine?</li><li>
Perform better in an orderly work environment that is free of clutter?</li></ul><p>
If this is you, we should talk.</p><p>
First, go to this page: https://go.cultureindex.com/p/n6hu69Wz715hd3rCdf1H to take a quick 8-10 minute survey and attach your resume.</p><p>
If we determine that you are a great fit, we will follow up with more information and a full description of responsibilities and benefits.</p><p></p><p><b><br>
About the Role</b></p><p><b>
Location</b> &ndash;
<br>
168 North 1950 West, Suite 102<br>
Salt Lake City, UT, 84116<br>
United States
<br>
<b>Background Check Required</b> &ndash; No<br>
<b>Drug Test Required</b> &ndash; No
<br>
<b>Schedule Code</b> &ndash; AC - Employees in Offices of Elected Officials</p><p><b>
Schedule: Monday - Friday 8 hour shift</b></p><p><b>
Why You Should Join Our Team</b><br>
In Utah, we believe hard work is important, but balance is essential. Finding work/life balance is a vital element to our culture. To find out more about WHY Utah, click here. Other benefits may include:</p><ul><li><b>
Job Stability: </b>Enjoy the security and reliability of employment within a well-established organization.</li><li><b>
Career Growth:</b><b> </b>Develop valuable skills and gain opportunities for leadership within a large organization.</li><li><b>
Meaningful Work: </b>Contribute to an important service that benefits the community and supports organizational goals.</li><li><b>
Supportive Work Environment:</b><b> </b>Be part of a team that values cooperation, strong work ethics, and mutual support.</li></ul><p><b>
The Agency</b><br>
Millions of dollars in lost or unclaimed money are turned over to the State of Utah every year. This money comes from places like dormant bank accounts, old stock certificates, and uncollected insurance checks. This is the official government website for managing and returning this unclaimed property to the residents of Utah.</p><p><b>
EEO Statement</b><br>
The State of Utah is committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity, or Veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirements. For accommodations, please contact (801) 957-9390.</p></div><div></div>

Claims Examiner I, Career Service Exempt

DriveTime Automotive Group

<div><p><b>What&rsquo;s Under the Hood</b></p><p></p><p>
DriveTime Family of Brands is the largest privately owned used car sales finance &amp; servicing company in the nation. Headquartered in Tempe, Arizona and Dallas, Texas, we create opportunities and improve the lives of our customers and our employees by placing a focus on putting the right customer, in the right vehicle, on the right terms and on their path to ownership.</p><p></p><p>
The DriveTime Family of Brands spans across DriveTime, Bridgecrest and SilverRock. You can find us at the intersection of technology and innovation as we use our proprietary tools and over two decades of industry knowledge to redefine the process of purchasing, financing, and protecting your vehicle.</p><p></p><p><b>
That&rsquo;s Nice, But What&rsquo;s the Job?</b></p><p></p><p><b>
In short,</b> the Corporate Claims Specialist II - Liability is a member of the Corporate Insurance &amp; Safety (CIS) Team and plays a key role in reducing the organization&rsquo;s total cost of risk. This position is responsible for independently managing designated auto and general liability claims while also overseeing TPA‑handled claims to ensure consistent strategy, timely resolution, and alignment with internal standards and risk objectives.</p><p></p><p><b>
In long, as the Corporate Claims Specialist II - Liability, you will be responsible for:</b></p><ul><li>
Independently manage assigned auto and general liability claims, including bodily injury and property damage exposures, from initial notice through resolution.</li><li>
Oversee auto and general liability claims administered by Third‑Party Administrators (TPAs), ensuring compliance with internal handling guidelines, authority thresholds, service expectations, and regulatory requirements.</li><li>
Establish and direct claim strategy by evaluating liability, damages, coverage, and exposure, including providing direction to TPAs to drive timely, cost‑effective outcomes.</li><li>
Exercise sound, independent judgment in determining claim direction, settlement approach, reserve adequacy, and escalation needs, with the ability to clearly document and defend decisions.</li><li>
Collaborate with internal stakeholders, field locations, TPAs, insurance carriers, and vendors to resolve complex, high‑severity, or sensitive claims.</li><li>
Manage reserves, settlement authority, and payment activity for in‑house claims, while reviewing and approving TPA reserve and settlement recommendations.</li><li>
Identify and pursue subrogation and recovery opportunities, either directly or through directed TPA efforts.</li><li>
Analyze claim metrics and performance data to assess trends, evaluate TPA effectiveness, support reporting needs, and recommend risk reduction or process improvement initiatives.</li></ul><p></p><p><b>
So What Kind of Folks Are We Looking For?</b></p><ul><li>
Detail‑oriented professionals who can manage in‑house claims while effectively overseeing third‑party claim handling.</li><li>
Strong communicators who can confidently direct TPA activity and collaborate with internal and external partners.</li><li>
Independent thinkers who can assess exposure, make defensible decisions, and hold others accountable to expectations.</li><li>
Organized, self‑motivated individuals who take ownership of outcomes and can pivot priorities efficiently and effectively.</li><li>
Team‑oriented professionals who value collaboration, transparency, and continuous improvement.</li><li>
Analytical problem‑solvers who enjoy using data and claim insight to drive smarter results.</li></ul><p></p><p><b>
The Specifics</b></p><ul><li>
Minimum of 3 years of auto bodily injury and/or general liability claims adjusting experience, including investigation, evaluation, negotiation, and resolution.<ul><li>
Experience with high complexity/high dollar claims is strongly preferred.</li><li>
Commercial or Business Insurance experience is a plus!</li></ul></li><li>
Experience working in a hybrid environment involving both direct claim management and TPA oversight is a plus.</li><li>
Ability to communicate clearly, professionally, and confidently across multiple stakeholders and formats.</li><li>
Proven ability to manage multiple systems and priorities in a fast‑paced environment.</li><li>
Intermediate Microsoft Office skills (Excel, Word, PowerPoint).</li><li>
Experience with Riskonnect, Salesforce, or similar claim management platforms preferred.</li><li>
Bachelor&rsquo;s degree preferred but not required.</li></ul><p></p><p><b>
So What About the Perks? Perks matter</b></p><ul><li><b>
We </b><b>take a hybrid work approach, </b>finding balance between the benefits of in-person and work-from-home environments. This position has an on-site expectation of a minimum of three days a week.</li><li><b>
Medical, dental, and vision, oh my!</b> DriveTime Family of Brands covers a sizable amount of insurance premiums to ensure our employees receive top-tier healthcare coverage.</li><li><b>
But Wait, There&rsquo;s More.</b> 401(K), Company paid life insurance policy, short and long-term disability coverage to name a few.</li><li><b>
Growth Opportunities.</b> You grow, I grow, we all grow! But seriously, DriveTime Family of Brands is committed to providing its employees with every opportunity to grow professionally with roughly over 1,000 employees promoted year over year.</li><li><b>
Tuition Reimbursement.</b> We&rsquo;re as passionate about your professional development as you are. With that, we&rsquo;ll put our money where our mouth is.</li><li><b>
Wellness Program.</b> Health is wealth! This program includes self-guided coaching and journeys, cash incentives and discounts on your medical premiums through engaging in fun activities!</li><li><b>
Gratitude is Green.</b> We offer competitive pay across the organization, because, well&hellip; money matters!</li></ul><p></p><ul><li><b>
In-House Gym.</b> We want our employees to be the best versions of themselves. So come early, take a break in your day or finish strong with a workout!</li><li><b>
Give Us a Reason (or not), and We&rsquo;ll Celebrate.</b> Regardless of whether there is a holiday or not, we are finding ways to kick back and enjoy each other&rsquo;s company outside of day-to-day work.</li><li><b>
Smart-Casual Dress.</b> Come dressed in jeans (you&rsquo;ll fit right in with the rest of us).</li><li><b>
Paid Time Off.</b> Not just lip service: we work hard, to play hard! Paid time off includes (for all full-time roles) wellness days, holidays, and good ole' fashioned YOU time! For our Part-timers, don't fear you get some time too...vacation time is available - the more you work, the more you earn!</li></ul><p></p><p><b>
Anything Else? Absolutely.</b></p><p></p><p>
DriveTime Family of Brands is Great Place to Work Certified! And get this: 90% of our rockstar employees say they feel right at home here. We could spend a lot of time having you read about ALL our awards, but we&rsquo;ll save time (and practice some humility) just naming a few others; Comparably Awards: Best Company for Diversity, Best Company Culture and Best Company Leadership, oh and don&rsquo;t forget Phoenix Business Journal Healthiest Employers (okay, we&rsquo;ll stop there)!</p><p></p><p>
Hiring is contingent upon successful completion of our background and drug screening process. DriveTime is a drug-free, tobacco-free workplace and an Equal Opportunity Employer.</p><p><br>
And when it comes to hiring, we don't just look for the right person for the job, we seek out the right person for DriveTime. Buckle up for plenty of opportunities to grow in a professional, fun, and high-energy environment!</p></div>

Corporate Claims Specialist II

Athens Administrators

<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

<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

Utica National Insurance Group

<div><p><b>The Company</b>
</p><p>At Utica National Insurance Group, 1,400 employees countrywide take our corporate promise to heart every day: To make people feel secure, appreciated, and respected.</p>
<p>
Utica National Insurance Group is an &quot;A&quot; rated $2.0B award-winning, nationally recognized property &amp; casualty insurance carrier.</p>
<p>
Operating along the Eastern half of the United States, based in our Home Office in Central New York, with Regional Office locations including NYC, Dallas and Charlotte.</p>
<p><b>
What you will do</b></p>
<p>
The Property Large Loss Examiner will handle personal and commercial large loss claims and complex claims. With attention to customer service and skills in investigation and negotiation, the Examiner will meet the needs of our insureds and engage in timely claims resolution. As a more senior individual contributor role, this position will require broad technical knowledge at an advanced level. This role will be a hybrid position reporting to New Hartford, NY; Buffalo, NY; or Charlotte, NC.</p>
<p><b>
Key responsibilities</b></p>
<ul>
<li>Direct handling of both personal and commercial large loss claims with a high level of customer service.</li>
<li>Handles Property claims of a complex nature; performs claims investigations and handles matters requiring broad technical knowledge at an expert level.</li>
<li>Operates on an independent basis with little supervision; mitigates, negotiates and settles claims within assigned authority with a strong focus of overall claim resolution.</li>
<li>Assist in selection, and some oversight, of independent adjusters and coverage counsel.</li>
<li>Reviews court decisions, and coverage interpretations, and is required to have a broad knowledge and understanding of Property law and claim practices.</li>
<li>Responsible for reporting on large losses, litigation reports and reports to reinsurance as needed.</li>
<li>Assists in the development and training of claims personnel in Property department.</li>
<li>Performs other tasks as assigned.</li>
</ul>
<p><b>What you need:</b></p>
<ul>
<li>4 year college degree preferred or equivalent experience.</li>
<li>4-8 years of Property claims experience demonstrating expertise in underlying coverages, broad background in litigated matters and development.</li>
</ul>
<p><b>Licensing</b></p>
<p>
Required to obtain your license(s) as an adjuster in the state(s) in which you are assigned to adjust claims. Licensing must be obtained within the timeframe set forth by the Company and must be maintained as needed throughout your employment.</p><br>
<p></p>
<p>
Salary range: $81,000 - $120,000</p>
<p>
The final salary to be paid and position within the internal salary range is reflective of the employee&rsquo;s work experience, their geographic location, education, certification(s), scope and responsibilities in the role, and additional qualifications.</p><br>
<p></p>
<p><b>
Benefits
</b></p><p>We believe strongly that talented people are core to our success and are attracted to companies that provide competitive pay, comprehensive benefits packages, career advancement and challenging work opportunities. We offer a Comprehensive Benefits Plan for full time employees that include the following:</p>
<ul>
<li>Medical and Prescription Drug Benefit</li>
<li>Dental Benefit</li>
<li>Vision Benefit</li>
<li>Life Insurance and Disability Benefits</li>
<li>401(k) Profit Sharing and Investment Plan (Includes annual Company financial contribution and discretionary Profit Sharing contribution based upon annual company financial results)</li>
<li>Health Savings Account (HSA)</li>
<li>Flexible Spending Accounts</li>
<li>Tuition Assistance, Training, and Professional Designations</li>
<li>Company-Paid Family Leave</li>
<li>Adoption/Surrogacy Assistance Benefit</li>
<li>Voluntary Benefits - Group Accident Insurance, Hospital Indemnity, Critical Illness, Legal, ID Theft Protection, Pet Insurance</li>
<li>Student Loan Refinancing Services</li>
<li>Care.com Membership with Back-up Care, Senior Solutions</li>
<li>Business Travel Accident Insurance</li>
<li>Matching Gifts program</li>
<li>Paid Volunteer Day</li>
<li>Employee Referral Award Program</li>
<li>Wellness programs</li>
<li>Personal Insurance Discount</li>
</ul>
<p><b>Additional Information:</b></p>
<p>
This position is a full time salaried, exempt (non overtime eligible) position.</p>
<p>
Utica National is an Equal Opportunity Employer.</p>
<p>
Apply now and find out what it&rsquo;s like to be a part of an amazing team, thrive in an exciting environment and work for a company you can be proud of. Once you complete your application, you can monitor your status in the hiring process by logging into your profile. A representative from our Talent Acquisition team will be in touch regarding any change in your candidacy.
</p><p>#LI-HL1</p></div>

Property Large Loss Examiner (hybrid)

DOCTORS HEALTHCARE PLANS, INC.

<div><p>The<b> Claims Examiner III </b>is a senior-level claims professional responsible for the accurate and timely adjudication of complex professional and institutional claims in accordance with regulatory requirements, contractual agreements, and internal policies. This role supports departmental workflow oversight, assists leadership with productivity and quality monitoring, and serves as a subject matter resource to team members to ensure operational excellence and compliance with CMS and organizational standards.<br>
<br>
<b>Key Responsibilities:</b></p><div><ul><li>
Review, analyze, and adjudicate professional and institutional claims, including high-dollar and complex cases.</li><li>
Process Member Reimbursement claims in accordance with plan benefits and regulatory guidelines.</li><li>
Ensure claims are processed accurately, timely, and in compliance with CMS regulations, state guidelines, and internal policies.</li><li>
Assist the Claims Manager and/or Assistant Director in monitoring daily, weekly, and monthly workflow to meet production and quality targets.</li><li>
Generate and analyze reports to track productivity, aging inventory, and pending items.</li><li>
Provide guidance and clarification to team members regarding claims processing rules, contract interpretation, and system functionality.</li><li>
Support the implementation and enforcement of departmental policies and procedures.</li><li>
Collaborate with leadership to ensure production, accuracy, and turnaround time metrics are consistently met.</li><li>
Communicate departmental goals, workflow strategies, and performance improvement initiatives to staff.</li><li>
Promote a positive work environment that supports staff engagement, accountability, and teamwork.</li><li>
Maximize system capabilities by ensuring proper utilization of claims processing tools and platforms.</li><li>
Identify process improvement opportunities and escalate system or configuration issues as needed.</li><li>
Perform additional duties as assigned.</li></ul><div><b>
Qualifications:</b></div></div><ul><li>
High School Diploma or GED</li><li>
Minimum of 3+ years of experience as a Medical Claims Examiner.</li><li>
Experience processing Medicare Advantage and/or managed care claims preferred.</li><li>
Strong experience with contract interpretation and benefit application.</li><li>
Working knowledge of CMS guidelines, Medicare regulations, and healthcare claims processing standards.</li><li>
Strong analytical and problem-solving skills.</li><li>
Proficiency in Windows-based systems and claims processing applications.<br>
</li></ul><div><i>
Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.</i></div><p><i>
No Third Party Agencies or Submissions Will Be Accepted.</i><br>
<br>
<i>Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP</i><br>
<br>
<i>Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.</i></p><p>
</p><p>3hOLMnYaLt</p></div>

Claims Examiner III

Benecard Services Inc.

<p></p><div><div><div><div><div><div>The Claims Examiner &ndash; Vision Insurance is a key contributor within the Claims Department, responsible for accurately adjudicating vision and eye care claims in compliance with Medicaid, Medicare, and commercial payer guidelines. This role supports operational excellence by ensuring timely payments, regulatory compliance, and high-quality service to providers and internal stakeholders. The Claims Examiner plays an active role in meeting departmental performance metrics and supporting audits, reporting, and workflow oversight.</div><div></div><div><br>
This is a fully on-site role, and employees are expected to report to the Clifton, New Jersey office five days per week and is a Union position.</div><div></div><div><b><br>
Key Responsibilities</b></div><ul><li>
Review, evaluate, and adjudicate vision and eye care insurance claims in accordance with payer guidelines, including Medicaid, Medicare, and Coordination of Benefits (COB) rules</li><li>
Process complex or high-dollar claims requiring supervisory overrides</li><li>
Distribute daily claim workloads and support operational workflow efficiency</li><li>
Prepare and maintain documentation for internal and external audits</li><li>
Ensure compliance with prompt pay regulations and timely filing requirements</li><li>
Research and resolve rejected, denied, or pending claims, including billing corrections and resubmissions</li><li>
Analyze remittance advice (EOBs/ERAs) and communicate findings as needed</li><li>
Support monthly claims reporting and departmental performance tracking</li><li>
Collaborate with leadership to meet monthly productivity and accuracy goals</li><li>
Respond promptly and professionally to internal and external communications</li><li>
Perform additional duties as assigned to support claims operations and leadership initiatives</li></ul><div></div><div><b><br>
Required Qualifications:</b></div><ul><li>
5+ years of experience adjudicating and processing healthcare claims, preferably in vision insurance or eye care</li><li>
Strong knowledge of Medicaid and Medicare claim processing</li><li>
Proficiency with CPT, ICD-10, HCPCS codes, and modifiers, including billing and coding edits</li><li>
Solid understanding of Third-Party Liability (TPL) and Coordination of Benefits (COB) rules</li><li>
Experience with electronic claims submission, clearinghouses, and billing resubmission processes</li><li>
In-depth knowledge of HCFA-1500 (CMS-1500) and electronic billing standards</li><li>
Familiarity with appeals and reconsideration processes for government payers</li><li>
Experience researching and resolving claim denials and timely filing issues</li><li>
Working knowledge of AS400 or similar claims processing systems</li><li>
Intermediate to advanced Microsoft Office skills, with emphasis on Excel</li><li>
Strong attention to detail, analytical skills, and ability to manage deadlines in a high-volume environment</li></ul><div></div><div><b><br>
Preferred Qualifications:</b></div><ul><li>
Previous leadership experience would be preferred</li><li>
Certified Professional Coder (CPC/CBC) and/or Certified Professional Biller (CPB)</li><li>
Prior experience in vision plans, optometry, ophthalmology, or eye care billing</li><li>
Experience supporting or participating in claims audits or compliance reviews</li></ul><div></div><div><b><br>
Why Join Us?</b></div><ul><li>
Be part of a collaborative claim&rsquo;s leadership-focused environment</li><li>
Opportunity to specialize in eye care and vision insurance claims</li><li>
Role offers stability, growth, and exposure to complex adjudication and compliance work</li></ul><p></p><p><br>
National Vision Administrators</p><p>
For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health &amp; Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care. We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.</p><p>
Website: http://www.e-nva.com</p><p>
We are an equal opportunity employer</p></div></div></div></div><br>
Monday - Friday 8:30am - 5:00pm</div>

Claims Examiner

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