Job Description
ATHENS POSITION DETAILS Position Title: Assistant Claims Examiner Department: Workers’ Compensation Texas Reports To: Claims Supervisor FLSA Status: Non-Exempt Job Grade: 6 Career Ladder: Next step in progression could include Future Medical Examiner or Claims Examiner Trainee ATHENS ADMINISTRATORS 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 “Best Place to Work.” 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 & Casualty, Program Business, and Managed Care. Embrace a change and come make an impact with the Athens Administrators family today! POSITION SUMMARY Athens Administrators has an immediate need for an experienced Assistant Claims Examiner to support our Texas Workers’ Compensation department. Employees who live less than 26 miles from the San Antonio, TX office are required to work once a week in the office on a day determined by their supervisor between Tuesday – Thursday. The remaining days can be worked remotely if technical requirements are met, and the employee resides in Texas. Athens offices are open for business Monday-Friday from 7:30 a.m. to 5:30 p.m. local time. The schedule for this position is Monday-Friday at 37.5 hours a week with the option of a flex schedule. The 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. PRIMARY RESPONSIBILITIES 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: Review, update claim coding and reassign new claims in compliance with client’s Service Agreement Approve all provider bills timely for Medical Only claims assigned Answer questions over the phone from medical providers regarding bills Contact treating physician for disability status Contact employer for return-to-work status or availability of modified work for medical only claims and as directed by Examiners Request Job Description from Employer Handle Medical Only claim files Documents file activity on computer Update information on computer, i.e. address changes, etc. Schedule appointments for IME evaluations Send appointment letters, send medical file Schedule interpreter for appointments, depositions, etc. Handle telephone calls for examiner as needed Complete file closing Complete preparation of documents for overnight delivery Work collaboratively with Senior Claims Examiners, Nurse Case Managers and other Assistant Claims Examiners Contact with clients, injured workers, doctors and vendors Answer phone calls/receptionist responsibilities ESSENTIAL POSITION REQUIREMENTS 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. High School Diploma or equivalent (GED) required for all positions AA/AS or BA/BS preferred but not required 2+ years’ Claims Assistant experience supporting a workers compensation examiner or team preferred Knowledge of worker injury laws, policies, and procedures Texas 03 WC or Texas 8 All Lines license required within one year Mathematical calculating skills Administrators Certificate from Self-Insurance Plans preferred Knowledge of workers compensation laws, policies, and procedures Understanding of medical and legal terminology Must demonstrate accuracy and thoroughness in work product Ability to sit for prolonged periods of time Well-developed verbal and written communication skills with strong attention to detail Excellent organizational skills and ability to multi-task Ability to type quickly, accurately and for prolonged periods Proficient in Microsoft Office Suite Ability to learn additional computer programs Reasoning ability, including problem-solving and analytical skills, i.e