Claim Processor jobs at Prime Therapeutics - 1294 jobs

* There are multiple positions open across the 26 states in which we operate. The current locations for which we are seeking CAT Claim Reps are located in the job posting.* Auto-Owners Insurance, a top-rated insurance carrier, is seeking an experienced and motivated claims professional to join our team. The position requires the following, but is not limited to: Frequent travel up to 21 days at a time and is required upon short notice to location of catastrophe, which would most likely be out of state. Can meet the physical demands required for the position including carrying and climbing a ladder. Investigate and assemble facts, determine policy coverage, evaluate the amount of loss, analyze legal liability and pay or deny losses. Familiar with insurance coverage by studying insurance policies, endorsements and forms. Work towards the resolution of claims, possibly attending arbitrations, mediations, depositions or trials as necessary. Ensure that claims payments are issued in a timely and accurate manner. Desired Skills & Experience Bachelor's degree or equivalent experience Minimum of 2 years claims handling experience or comparable experience Field claims experience with multi-line property and casualty claims and wind/hail Proficient with Xactimate software Above-average communication skills (written and verbal) Ability to resolve complex issues Organize and interpret data Ability to handle multiple assignments Possess a valid driver's license Military experience is considered Benefits Competitive salary, matching 401(k) retirement plans, fully funded pension plan, bonus programs, paid holidays, vacation days, personal days, paid sick leave and a comprehensive health care plan. Equal Employment Opportunity Auto-Owners Insurance is an equal opportunity employer. The Company hires, transfers, and promotes on the basis of ability, without consideration of disability, age, sex, race, color, religion, height, weight, marital status, sexual orientation, gender identity or national origin, or any factor contrary to federal, state or local law. * Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.

Network Adjusters is seeking an experienced General Liability and/or Construction Defect Claims Supervisor to join our third-party administrative insurance handling team. This leadership role is ideal for professionals who thrive in fast-paced claims environments and are passionate about team development, technical excellence, and delivering strong customer service outcomes. This position offers the opportunity to work within a trusted organization committed to integrity, reliability, and professional development through ongoing training and growth opportunities. About the Role General Liability Claims Supervisors oversee the full lifecycle of claims handling while ensuring compliance, service standards, and industry best practices are consistently met. In this role, you will hire, onboard, train, and develop a team of adjusters specializing in general liability and construction defect claims, providing both strategic and technical guidance throughout the claims process. You will play a key role in maintaining departmental protocols, supporting complex claim resolution, and delivering strong customer service outcomes for carriers, clients, and internal stakeholders. This is a desk-based role. Responsibilities Supervise and manage a team of claims adjusters, providing guidance, training, and ongoing support to drive performance and professional development Hire, onboard, train, and develop staff as needed Review and analyze coverage, policies, claim forms, and supporting documentation to ensure accurate and compliant claim handling Oversee the full claims lifecycle, including damage evaluation, loss determination, settlement negotiations, and resolution Ensure compliance with all regulatory requirements, company guidelines, and industry Best Practices Implement and monitor quality control standards and QA/QC measures to ensure consistency, accuracy, and efficiency in claims handling Collaborate with carriers, attorneys, claimants, and internal stakeholders to resolve disputes and provide a positive claims experience Track and analyze team and departmental performance metrics, establish targets, and implement strategies to meet or exceed goals Prepare and present reports to senior management and clients, highlighting performance trends, risks, and improvement opportunities Stay current on industry regulations, case law, statutes, and evolving claims best practices Qualifications Minimum 5 years of claims handling experience in General Liability or Construction Defect claims Minimum 3 years of supervisory or managerial experience, preferably within insurance claims Strong leadership skills with the ability to mentor, motivate, and develop a team Superior knowledge of case law, statutes, and procedures impacting claim handling and valuation Excellent analytical, evaluation, strategic, and negotiation skills Ability to prioritize workload and manage multiple tasks effectively in a fast-paced environment Strong problem-solving skills with keen attention to detail Proficiency in MS Office Suite and other standard business software Polished written and verbal communication skills Bachelor's degree in a relevant field or equivalent work experience Compensation & Benefits Salary: $110,000-$140,000 annually (based on licensure, certifications, and experience) Training, development, and career growth opportunities 401(k) with company match and retirement planning Paid time off and company-paid holidays Comprehensive medical, dental, and vision insurance Flexible Spending Account (FSA) Company-paid life insurance and long-term disability Supplemental life insurance and optional short-term disability Strong work/family and employee assistance programs Employee referral program Location 📍 Denver, CO Remote opportunities may be available for experienced candidates who meet all required criteria. About Network Adjusters Founded in 1958, Network Adjusters has built a reputation as a leading provider of insurance claims administration and independent adjusting services. Serving the insurance industry for nearly seven decades, Network Adjusters, Inc. brings together the best elements of third-party claims administration and independent adjusting services. From our primary offices in New York, Denver, and Kentucky to our national network of experts, our superior experience and ongoing training are the keys to successfully managing our clients claims and handling specialized insurance needs. All our Claim Directors have extensive backgrounds working with major insurance carriers, giving us a thorough understanding of factors critical claims handling. It all adds up to measurable results-the proof is in our extensive track record of settled claims and unmatched recovery abilities.

We seek to make a meaningful impact in the lives of our customers and our communities. The LTD Claim Consultant evaluates long term disability insurance claims in accordance with plan provisions and within prescribed time service standards. In this role, the LTD Claims Consultant is required to exercise independent judgment, critical thinking skills, exemplary customer service skills as well as effective inventory management skills. Essential Business Experience and Technical Skills: Required: **3+ years of LTD/IDI Insurance Claims experience •Prior experience with independent judgement and decision making while relying on the available facts •Be able to demonstrate the use of critical thinking and analysis when reviewing the information •Creative problem-solving abilities and the ability to think outside the box •Excellent interpersonal and communication skills in both verbal and written form •Excellent customer service skills proven through internal and external customer interactions •Demonstrated conceptual thinking, risk management, ability to handle complex situations effectively •Organizational and time management skills • Bachelor's degree Key Responsibilities: •Effectively manages with some level of oversight an assigned caseload of moderately complex claims which consists of pending, ongoing/active and appeal reviews. The LTD CS will be evaluated for increases in their authority levels as they become more experienced in their decision-making and demonstrate consistency in meeting all key performance indicators •Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment and in accordance with state and department of insurance regulations • Provides frequent, proactive verbal communication with our claimants and/or their representatives demonstrating empathy and active listening while providing clear updates, direction and explanations regarding the claim process, benefits and other pertinent plan provisions. These calls are used to gather essential details regarding medical condition(s) and treatment, occupational demands, financial information and any other information that may be pertinent to the evaluation of the claim. Once telephone calls are completed, you will be required to document the conversation within the claim file in a timely manner utilizing the appropriate level of detail and professional writing skills •Interacts and communicates effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations •Compiles file documentation and correspondence requiring extensive policy and factual detail. Analyzes information to determine if additional information is needed to make a reasonable and logical claims determination based off the information available •Collaborates with both external and internal resources, such as physicians, attorneys, clinical/vocational consultants as needed to gather data such as medical/occupational information in order to ensure reasonable, thorough decisions. •Clarifies and reconciles inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed •Proficiently calculates monthly benefits due after elimination period, to include COLA, Social Security Offsets, and Rehab Return to Work benefits, and other non-routine payments •Provides timely and detailed written communication during the claim evaluation process which outlines the status of the evaluation and/or claim determination. •Addresses and resolves escalated customer complaints in a timely and thorough manner. Identifies and refers appropriate matters to our appeals, complaint, or litigation support areas.

Network Adjusters is seeking an experienced First-Party Property Damage Claims Supervisor to join our third-party administrative insurance handling team. This leadership role is ideal for professionals who thrive in fast-paced claims environments and are passionate about team development, technical excellence, and delivering strong customer service outcomes. This position offers the opportunity to work within a trusted organization committed to integrity, reliability, and professional development through ongoing training and growth opportunities. About the Role Property Claims Supervisors oversee the full lifecycle of claims handling while ensuring compliance, service standards, and industry best practices are consistently met. In this role, you will hire, onboard, train, and develop a team of adjusters specializing in commercial property losses, providing both strategic and technical guidance throughout the claims process. You will play a key role in maintaining departmental protocols, supporting complex claim resolution, and delivering strong customer service outcomes for carriers, clients, and internal stakeholders. This is a desk-based role. Responsibilities Supervise and manage a team of claims adjusters, providing guidance, training, and ongoing support to drive performance and professional development Hire, onboard, train, and develop staff as needed Review and analyze coverage, policies, claim forms, and supporting documentation to ensure accurate and compliant claim handling Oversee the full claims lifecycle, including damage evaluation, loss determination, settlement negotiations, and resolution Ensure compliance with all regulatory requirements, company guidelines, and industry Best Practices Implement and monitor quality control standards and QA/QC measures to ensure consistency, accuracy, and efficiency in claims handling Collaborate with carriers, attorneys, claimants, and internal stakeholders to resolve disputes and provide a positive claims experience Track and analyze team and departmental performance metrics, establish targets, and implement strategies to meet or exceed goals Prepare and present reports to senior management and clients, highlighting performance trends, risks, and improvement opportunities Stay current on industry regulations, case law, statutes, and evolving claims best practices Qualifications Minimum 5 years of claims handling experience, including first-party property claims Strong leadership skills with the ability to mentor, motivate, and develop a team Superior knowledge of case law, statutes, and procedures impacting claim handling and valuation Excellent analytical, evaluation, strategic, and negotiation skills Ability to prioritize workload and manage multiple tasks effectively in a fast-paced environment Strong problem-solving skills with keen attention to detail Proficiency in MS Office Suite and other standard business software Polished written and verbal communication skills Bachelor's degree in a relevant field or equivalent work experience Compensation & Benefits Salary: $85,000-$110,000 annually (based on licensure, certifications, and experience) Training, development, and career growth opportunities 401(k) with company match and retirement planning Paid time off and company-paid holidays Comprehensive medical, dental, and vision insurance Flexible Spending Account (FSA) Company-paid life insurance and long-term disability Supplemental life insurance and optional short-term disability Strong work/family and employee assistance programs Employee referral program Location 📍 Denver, CO This role is on-site only; remote or hybrid arrangements are not available. About Network Adjusters Founded in 1958, Network Adjusters has built a reputation as a leading provider of insurance claims administration and independent adjusting services. Serving the insurance industry for nearly seven decades, Network Adjusters, Inc. brings together the best elements of third-party claims administration and independent adjusting services. From our primary offices in New York, Denver, and Kentucky to our national network of experts, our superior experience and ongoing training are the keys to successfully managing our clients claims and handling specialized insurance needs. All our Claim Directors have extensive backgrounds working with major insurance carriers, giving us a thorough understanding of factors critical claims handling. It all adds up to measurable results-the proof is in our extensive track record of settled claims and unmatched recovery abilities.

The Auto Property Damage Claims Representative is responsible for managing Auto Property Damage claims within our “Auto PD Claim Unit.” This role demands a high level of customer service, patience, and professionalism while working in a fast-paced environment with significant phone interaction. Strong customer service, organizational, verbal, and written communication skills are essential. The ability to navigate adversarial situations with professionalism is critical. Comparative negligence claim handling experience is a plus but not required. RESPONSIBILITIES Policy Analysis: Investigate and interpret policy provisions, endorsements, and conditions to determine coverage for automobile property claims. Identify and investigate contested coverage claims that may require a roundtable discussion. Claim Investigation: Investigate auto accidents to assess liability by interviewing first- and third-party claimants, witnesses, investigating officers, and other relevant parties. Secure and analyze pertinent records, documentation, and loss scene information to determine proximate cause, negligence, and damages. Claims Management: Evaluate and adjust reserves as necessary. Prepare dispatch instructions for field personnel to inspect vehicles. Negotiate and settle claims within individual authority limits and seek supervisor approval for claims exceeding authority or requiring additional guidance. Maintain effective follow-up systems on pending files, advising insureds, claimants, and brokers on claim status. Act as an intermediary between the company, preferred vendors, and customers to resolve disputes. Ensure adherence to privacy guidelines, laws, and regulations in claims handling. Subrogation and Legal Handling: Investigate and initiate subrogation processes when applicable. Handle and respond to special civil part lawsuits or intercompany arbitrations related to auto property damage claims. Administrative Duties: Manage a customer-focused phone environment by answering calls, returning voicemails, and responding to emails and text correspondence promptly. Process incoming and outgoing mail timely and in accordance with state guidelines. Complete other duties as assigned. QUALIFICATIONS Bachelor's degree required. A minimum of 1 year of related PD claim experience is welcomed but not required. Proficiency in personal computer skills, including Microsoft Office Suite. Ability to prioritize and manage multiple tasks effectively. Excellent communication, organizational, and customer service skills. SALARY RANGE The pay range for this position is $47,000 to $55,000 annually. Actual compensation will vary based on multiple factors, including employee knowledge and experience, role scope, business needs, geographical location, and internal equity. PERKS & BENEFITS 4 weeks accrued paid time off, 8 paid national holidays per year, and 2 floating holidays Low cost and excellent coverage health insurance options that start on Day 1 (medical, dental, vision) Annual 401(k) Employer Contribution Resources to promote Professional Development (LinkedIn Learning and licensure assistance) Robust health and wellness program and fitness reimbursements Various Paid Family leave options including Paid Parental Leave Tuition Reimbursement ABOUT THE COMPANY The Plymouth Rock Company and its affiliated group of companies write and manage over $2 billion in personal and commercial auto and homeowner's insurance throughout the Northeast and mid-Atlantic, where we have built an unparalleled reputation for service. We continuously invest in technology, our employees thrive in our empowering environment, and our customers are among the most loyal in the industry. The Plymouth Rock group of companies employs more than 1,900 people and is headquartered in Boston, Massachusetts. Plymouth Rock Assurance Corporation holds an A.M. Best rating of “A-/Excellent”.

This is a Hybrid position at our Rancho Cordova, CA branch. Please sign the application at the end. SIP required At the Direction of the Claims Supervisor and/or Manager - manages all aspects of complex and litigated indemnity claims from inception to conclusion within established authority and guidelines. This position requires considerable interaction with clients, claimants, Medical providers, Attorneys, vendors, Nurse and Vocational Case Managers and other TRISTAR staff. DUTIES AND RESPONSIBILITIES: Effectively manages a caseload of indemnity claim files, including very complex and litigated claims.* Initiates and conducts investigation in a timely manner.* Determines compensability of claims and administer benefits based upon state law and TRISTAR Best Practices for claim handling.* Manages medical treatment and medical billing, authorizing as appropriate.* Refers cases to outside defense counsel and participates in litigated matters.* Communicates with claimants, attorneys, providers and vendors regarding claims issues.* Work in an organized and proactive manner.* Computes and set reserves within Company guidelines.* Settles and/or finalize all claims and obtains authority as designated.* Maintains diary system for case review and documents file to reflect the status and work being performed on the file, including a plan of action.* Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.* Conducts file reviews as scheduled by the client and management.* Identify and review claims for Apportionment assignment.* Identify and investigate subrogation potential and pursue recovery.* Identify claim standard criteria for excess reporting and reimbursement.* Assist with State Audit and reporting responses.* Mentors less experienced Examiners Other duties as assigned and including claims management of other jurisdictional workers' comp claims. Adheres to all TRISTAR company policies and procedures.* * Essential job function. Qualifications Education/Experience: Minimum five (5) or more years related experience; or equivalent combination of education and experience. HS diploma required, BS preferred Knowledge, Skills and Abilities: Technical knowledge of statutory regulations and medical terminology. Analytical skills. Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff. Ability to interact with persons at all levels in the business environment. Ability to independently and effectively manage very complex claims. Proficient in Word and Excel (preferred). Other Qualifications: Licenses as required by Jurisdiction.. SIP required Here are some of the benefits you can enjoy in this role: Medical, Dental, Vision, Disability & Life insurance. 401(K) plan Paid time off Paid holidays Referral bonus

Must have a NY Adjuster's license or be willing to pass the test and obtain a NY Adjuster's license within 60 days of hire. Under minimal supervision, the Claims Examiner III Team Leader reports to the Claim Supervisor and/or Area Manager and manages all aspects of Auto Liability and Property claims handling from inception to conclusion within established authority and guidelines. This position requires considerable interaction with clients, claimants on the phone, TRISTAR management, other TRISTAR staff, and Claims Examiners, and Claims Examiners reporting directly to the Claims Examiner III Team Leader. DUTIES AND RESPONSIBILITIES: Effectively manages a caseload of 75-100 Auto Liability and Property files, including large exposure reportable claims. * Initiates and conducts investigations in a timely manner for claims assigned. * Determines compensability of claims and administers benefits, based upon state law and in accordance with established Company and client guidelines. * Communicate with clients, claimants, providers, and vendors regarding claims issues. * Computes and sets reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II. * Settles and/or finalizes all claims assigned and obtains authority as designated. * Maintains a diary system for case review and documents file to reflect the status and work being performed on the file assigned. * Communicates appropriate information promptly to the Area Manager client to resolve claims efficiently, including any injury trends or other safety-related concerns. * Provides overall supervision, guidance, and support with 2-3 direct reports, TRISTAR adjusters on the Tower/Venture Leasing Team, whose duties are similar to those outlined above for claims they are assigned by the Claims Examiner III Team Leader * Adheres to all Company policies and procedures. * Conducts file reviews independently. * Other duties as assigned. * Essential job function. EQUIPMENT OPERATED/USED: Computer and other office equipment. SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire when on video or attending client meetings Qualifications QUALIFICATIONS REQUIRED: Education/Experience degree in related field (preferred); three (3) or more years related experience; or equivalent combination of education and experience. Knowledge, Skills, and Abilities: Technical knowledge of coverage, statutory regulations, and medical terminology. Analytical skills. Excellent written and verbal communication skills, including the ability to convey technical details to claimants, clients, and staff. Ability to interact with persons at all levels in the business environment. Ability to independently and effectively manage very complex claims. Proficient in Word and Excel (preferred). Other Qualifications: Active General Adjuster New York State License Mental and Physical Requirements: [see separate attachments for a copy of the checklist of mental and physical requirements} MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORTa. Reasoning development:Follow one- or two-step instructions, routine, repetitive task.Carry out detail but uninvolved written or verbal instructions, deal with a few concrete variables.Follow written, verbal, or diagrammatic instructions, several concrete variables.Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development:Simple additional and subtraction; copying figures, counting, and recording. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Add, subtract, multiply, and divide whole numbers.X Arithmetic calculations involving fractions, decimals, and percentages.Arithmetic, algebraic, and geometric calculations.Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination requires theoretical application. c. Language development:Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.X Ability to compose original correspondence, follow technical manuals, and have increasedcontact with people.Ability to report, write, or edit articles for publication; prepare deeds, contracts, or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PHYSICAL EFFORTa. Physical activity required to perform the job:Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.X Light work:a. Exerting up to 20 pounds of force occasionallyb. Exerting up to 10 pounds frequentlyc. Exerting a negligible amount of force constantly to move objects(If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work).Medium work:a. Exerting up to 50 pounds of force occasionallyb. Exerting up to 20 pounds of force frequentlyc. Exerting up to 10 pounds of force constantly to move objects Heavy work:a. Exerting up to 100 pounds of force occasionallyb. Exerting up to 50 pounds of force frequentlyc. Exerting up to 20 pounds of force constantly to move objects Very heavy work:a. Exerting in excess of 100 pounds of force occasionallyb. Exerting in excess of 50 pounds of force constantly to move objectsc. Exerting in excess of 20 pounds of force constantly to move objects b. Visual requirements necessary to perform the job:Far vision: clarity of vision at 20 feet or moreX Near vision: clarity of vision at 20 inches or less Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g.,continually, frequently, or occasionally):Climbing: Ascending or descending ladders, stairs, scaffolding,ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion.Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium.X Stooping: Bending body downward and forward by bending spine atthe waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. OccasionallyOccasionally X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet X Kneeling: Bending legs at knee to come to a rest on knee or knees.X Crouching: Bending the body downward and forward by bending legs and spine.Crawling: Moving about on hands and knees or hands and feet.X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time.X Pushing: Using upper extremities top press against something withsteady force in order to thrust forward, downward, or outward.FootMotion: Using feet to push pedals.X Lifting: Raising objects from a lower to a higher position or movingobjects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles.X Fingering: Picking, pinching, typing, or otherwise working with fingersrather than with the whole hand or arm as in handling.X Grasping: Applying pressure to an object with the fingers and palm. OccasionallyOccasionallyOccasionallyOccasionallyOccasionallyOccasionallyFrequentlyFrequentlyOccasionally X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. 2. PHYSICAL EFFORT (cont.) FREQUENCY X Talking: Expressing or exchanging ideas by means of the spokenword. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly.X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts.Feeling: Perceiving attributes of objects, such as size, shape, FrequentlyFrequently temperature, or texture by touching with skin, particularly that of fingertips.X Repetitive Substantial movements (motions) of the wrists, hands,Motion: and/or fingers. Frequently 3. WORKING CONDITIONSDisagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITIONENVIRONMENTALFACTOR NATURE/REASONOF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes Other (specify):

Please make sure that you complete all the questions and navigate to the end of the application to sign the application. Investigates, evaluates, disposes, and settles moderately complex to complex/high exposure claims. Includes the investigation, evaluation, and determination of coverage, compensability, and responsibility, and the setting of proper reserves. DUTIES AND RESPONSIBILITIES: Processes moderately complex to complex or high exposure claims consistent with clients' and corporate policies, procedures, and “Best Practices” and in accordance with any statutory, regulatory, and ethics requirements. Independently analyzes claim exposure, determines a proper plan of action to appropriately mitigate and settle/close the claim, working within the established level of authority. Interacts with injured workers, client contacts, and attending Physician(s) to ensure awareness and understanding of the Workers' Compensation process, requirements, and entitlements. Interacts with disability and leave examiners for coordination of non-occupational benefits. Prepares and issues notices in accordance with mandated requirements and regular reviews and stays abreast of applicable laws, rules, and regulations that may impact how claims are processed. Establishes and maintains proper reserving throughout the life of the claim. Identify subrogation potential and pursue the process for reimbursement. Complies with carrier excess reporting and threshold requirements. Coordinates medical treatment for injured workers and provides information to treating physicians(s) regarding the employee's medical history, health issues, and job requirements. Fully understands Medicare reporting requirements as they relate to a Workers' Compensation claim. Facilitates early RTW through temporary, transitional, alternate, or modified work. Manages all medical aspects of a claim file with a focus on RTW and end of treatment. Refers appropriate files for task management assignments to approved vendors for medical management, special investigative needs, conditional payments, etc., up to assigned authority. Monitors' status and quality of work performed. Serves as a liaison between medical providers, employees, legal professionals, clients, and vendors. Independently manages claims in litigation with regular and consistent communication with defense counsel to make recommendations and develop a strategy. Enters and maintains accurate information in the claims management computer system. Clearly communicates concise action plans and presents plans for moving the claim to resolution. Meets with clients to discuss ongoing claims or review open claim inventory. Effectively controls expenses on all Workers' Compensation claims. Mentors first-level WC Examiners. All other duties as assigned. EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer and other office equipment. SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire. Qualifications QUALIFICATIONS REQUIRED: Education: High School Diploma or GED required: Bachelor's degree in related field (strongly preferred) or equivalent combination of education and experience. Experience: Three (3) to five (5) years of Workers' Compensation Claims administration experience required, working with self-insured and/or insured claims. Preferred Skills: Demonstrated experience working with complex, high-exposure, and litigated WC claims. Appropriately licensed and/or certified in all States in which claims are handled. Multi-Jurisdiction experience is a (+). Bilingual Spanish is a (+) Able to work in a fast-paced, high-stress, changing environment. Strong analytical, critical thinking, and problem-solving skills are required. Effective verbal and written communication skills required. Excellent planning, organizing, and negotiation skills required. Attention to detail. Negotiation and interpretive skills are necessary. Demonstrated knowledge of established claims strategy and mitigation techniques. Establishes and maintains effective working relationships with those contacted in the course of work. Proficiency with computers and technology - working knowledge of Microsoft Office application suite (MS Word, Excel, etc. and familiarity and experience using standard claims administration applications. Good interpersonal skills with an ability to work within a team environment. Able to effectively handle multiple priorities simultaneously. Works independently. Here are some of the benefits you can enjoy in this role: Medical, Dental, Vision Insurance. Life and Disability Insurance. 401(k) Plan Paid Holidays Paid Time Off. Referral bonus. Mental and Physical Requirements: [see separate attachment for a copy of the checklist of mental and physical requirements] MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORT a. Reasoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detailed but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development: Simple addition and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination, require theoretical application. c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PHYSICAL EFFORT a. Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects Heavy work: a. Exerting up to 100 pounds of force occasionally b. Exerting up to 50 pounds of force frequently c. Exerting up to 20 pounds of force constantly to move objects Very heavy work: a. Exerting in excess of 100 pounds of force occasionally b. Exerting in excess of 50 pounds of force constantly to move objects c. Exerting in excess of 20 pounds of force constantly to move objects Visual requirements necessary to perform the job: Far vision: clarity of vision at 20 feet or more X Near vision: clarity of vision at 20 inches or less X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. X Kneeling: Bending legs at knee to come to a rest on knee or knees. X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time. X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals. X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles. X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. X Grasping: Applying pressure to an object with the fingers and palm. Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally 2. PHYSICAL EFFORT (cont.) FREQUENCY X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. Frequently Frequently Frequently 3. WORKING CONDITIONS Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITION ENVIRONMENTAL FACTOR NATURE/REASON OF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes

will be Hybrid BE SURE TO SIGN THE APPLICATION WHEN YOU APPLY Investigates, evaluates, disposes and settles moderately complex to complex/high exposure claims. Includes the investigation, evaluation and determination of coverage, compensability and responsibility and the setting of proper reserves. DUTIES AND RESPONSIBILITIES: Processes moderately complex to complex or high exposure claims consistent with clients' and corporate policies, procedures and “Best Practices” and in accordance with any statutory, regulatory and ethics requirements. Independently analyzes claim exposure, determines a proper plan of action to appropriately mitigate and settle/close the claim working within established level of authority. Interacts with injured workers, client contacts and attending Physician(s) to ensure awareness and understanding of the Workers' Compensation process, requirements and entitlements. Interacts with disability and leave examiners for coordination of non-occupational benefits. Prepares and issues notices in accordance with mandated requirements and regularly reviews and stays abreast of applicable laws, rules and regulations that may impact how claims are processed. Establishes and maintains proper reserving throughout the life of the claim. Identify subrogation potential and pursue the process for reimbursement. Complies with carrier excess reporting and threshold requirements. Coordinates medical treatment for injured workers and provides information to treating physician(s) regarding the employee's medical history, health issues and job requirements. Fully understands Medicare reporting requirements as they relate to a Workers' Compensation claim. Facilitates early RTW through temporary, transitional, alternate, or modified work. Manages all medical aspects of a claim file with a focus on RTW and end of treatment. Refers appropriate files for task management assignments to approved vendors for medical management, special investigative needs, conditional payments, etc. up to assigned authority. Monitors status and quality of work performed. Serves as a liaison between medical providers, employees, legal professionals, clients and vendors. Independently manages claims in litigation with regular and consistent communication with defense counsel to make recommendations and develop strategy. Enters and maintains accurate information in the claims management computer system. Clearly communicates concise action plans and present plans for moving the claim to resolution. Meets with clients to discuss on-going claims or review open claim inventory. Effectively controls expenses on all Workers' Compensation claims. Mentors first level WC Examiners. All other duties as assigned. Qualifications QUALIFICATIONS REQUIRED: this is a hybrid position....please sign the application at the end Education: High School Diploma or GED required: Bachelor's degree in related field (strongly preferred) or equivalent combination of education and experience. Experience: Three (3) to five (5) years of Workers' Compensation Claims administration experience required working with self-insured and/or insured claims. Licenses/Certificate: SIP Preferred Skills: Demonstrated experience working with complex, high exposure and litigated WC claims. Appropriately licensed and/or certified in all States in which claims are being handled. Multi-Jurisdiction experience is a (+). Bilingual Spanish is a (+) Able to work in a fast paced, high stress, changing environment. Strong analytical, critical thinking and problem-solving skills required. Effective verbal and written communication skills required. Excellent planning, organizing and negotiation skills required. Attention to detail. Negotiation and interpretive skills necessary. Demonstrated knowledge of established claims strategy and mitigation techniques. Establishes and maintains effective working relationships with those contacted in the course of work. Proficiency with computers and technology - working knowledge of Microsoft Office application suite (MS Word, Excel, etc. and familiarity and experience using standard claims administration applications. Good interpersonal skills with an ability to work within a team environment. Able to effectively handle multiple priorities simultaneously. Works independently. Here is some of the benefits you can enjoy in this role Medical, Dental, Vision, Life insurance & Disability 401 (k) plan Paid holidays. Paid time off. Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements] MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORT a. Reasoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application. c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PHYSICAL EFFORT a. Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects Heavy work: a. Exerting up to 100 pounds of force occasionally b. Exerting up to 50 pounds of force frequently c. Exerting up to 20 pounds of force constantly to move objects Very heavy work: a. Exerting in excess of 100 pounds of force occasionally b. Exerting in excess of 50 pounds of force constantly to move objects c. Exerting in excess of 20 pounds of force constantly to move objects Visual requirements necessary to perform the job: Far vision: clarity of vision at 20 feet or more X Near vision: clarity of vision at 20 inches or less X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. X Kneeling: Bending legs at knee to come to a rest on knee or knees. X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time. X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals. X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles. X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. X Grasping: Applying pressure to an object with the fingers and palm. Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally 2. PHYSICAL EFFORT (cont.) FREQUENCY X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. Frequently Frequently Frequently 3. WORKING CONDITIONS Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITION ENVIRONMENTAL FACTOR NATURE/REASON OF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes

This position will be office-based during the required training, which may last up to 6 months. Once training is complete, the position may become hybrid or 100% remote-based subject to company remote-work policies. Working permanently on a remote or hybrid schedule is not a guarantee for this position. POSITION SUMMARY: Under general supervision, the Claims Analyst adjudicates claims in accordance with procedures and operations of group benefit plans. The Claims Analyst processes entry to mid-level complex claims accurately and pays health claims for medical, prescription, dental, vision, and partially self-funded benefit plans. DUTIES AND RESPONSIBILITIES: Process timely and accurately claims in accordance with the group plan self-funded benefit specifications for all healthcare benefits. Process timely and accurately claims in accordance with the Facility and Provider Network and Pharmacy Benefit Manager requirements. Ability to monitor, correctly apply and appropriately use modifiers as defined in the Current Procedural Terminology (CPT) reference book to ensure accurate benefit application. Must have a working knowledge of ICD10 Codes, CPT Codes, HCPC Codes and ADA Codes. Ability to recognize and accurately process claims for multiple services (i.e., surgeries, anesthesia, hospital [inpatient/outpatient], post-operative visits, physical therapy, office visits with or without lab or Xray services, etc.) Ability to recognize and appropriately process claims submitted for services rendered using Benefit Categories as defined by the TRISTAR claims processing system to ensure accurate payment. Process accurately out-of-network (OON) or referenced based pricing (RBP) claims as applicable. Understand Coordination of Benefits rules and be able to apply coordinated benefits in the claims process. Ability to identify claims that require additional information and create system letters for other Insurance, Accident inquiries, and Pre-Determinations. Process responses to requests for additional information and take appropriate steps to facilitate the completion of claim processing and escalation ( i.e. coordination of benefits, identification of possible subrogation claims). Work collaboratively with the Director of Operations, and with team members in the departments of: Claims, Member and Provider Services Eligibility and Enrollment, Auditing, and Cafeteria Plan (Section 125) administration as applicable to ensure accurate claims processing. When working a hybrid or 100% remote-based schedule, must attend required company or division training, meetings, company sponsored activities/events, job related and required business travel as applicable. Ensure, when working a hybrid or 100% remote-based schedule that all communication and system resources such as instant messaging (Teams Chat), email, Teams Meetings, or other available resources or forms of communication are frequently used to stay in touch with the team, supervisors, and others within the organization. Timely report to the supervisor any system downtimes or interruptions whether working remotely, hybrid, or in the office. Obtain and maintain, in good standing, individual Claim Analyst licenses as required by the client, insured program, service agreement, or state regulators. Regular attendance in accordance with hours of operation are essential functions of the job. Perform other duties as assigned. EQUIPMENT OPERATED/USED: Computer, 10-key, printer, copier, fax machine and other office equipment. SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire required when working in the office and when conducting business with internal/external personnel remotely or on a hybrid schedule. Qualifications QUALIFICATIONS REQUIRED: Education/Experience: High school diploma or GED and two (2) years of experience working with health claims or member and provider services in the healthcare industry, or similar. Knowledge, Skills and Abilities: Highly detail oriented, exhibit excellent problem-solving skills and able to consistently perform at minimum or higher production. Extremely dependable and reliable; able to adapt to changes. Must have a positive attitude towards work and co-workers. Excellent communication skills both verbal and written are necessary. Ability to work independently, and in a team environment. Must understand and comply with applicable HIPAA, Privacy, and Security policies, regulations, and laws. Ability to work collaboratively with various departments and teams. Ability to maintain composure under stressful conditions. Ability to communicate in English clearly and concisely, both orally and in writing Possess an extensive working knowledge of medical terminology and medical procedures. Understand the importance of practicing good ergonomics in the workplace.

DETAILS Assistant Claims Examiner - Flex Department: Workers' Compensation 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 - Flex to support our Workers' 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 - 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 - 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. 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: Process new claims in compliance with client's Service Agreement Issue all indemnity payments and awards on time Process all approved provider bills timely Prepare objection letters to providers for medical bills; delayed, denied, lacking reports. 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. Contact injured worker at initial set up Send DWC notices timely Issue SJDB Notices timely Request Job Description from Employer Handle Medical Only claim files Calculate wage statements and adjust disability rates as required Keep diary for all delay dates and indemnity payments Documents file activity on computer Update information on computer, i.e., address changes, etc. Schedule appointments for AME, QME evaluations Send appointment letters, issue TD/mileage, send medical file Schedule interpreter for appointments, depositions, etc. Request Employer's Report, DWC-1, Doctor's First Report if needed Verify mileage and dates of treatment for reimbursement to claimant Subpoena records File and serve documents on attorneys, WCAB, doctors Serve PTP's with medical file and Duties of Treating Physician (9785) Request PD ratings from DEU Draft Stipulated Awards and C&R's Submit C&R, Stipulated Awards to WCAB for approval with documentation Process checks - stop payment, cancellations, void, journal payments Handle telephone calls for examiner as needed Complete penalty calculations and prepare penalty worksheets Complete MPN, HCO and/or EDI coding Complete referrals to investigators 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, attorneys, doctors, vendors, and other parties Provide updates of claims status to Senior Claims Examiners and Athens management Prepare professional, well written correspondence and other communications 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 Medical Only Adjuster designation required Continuing hours must be current Mathematical calculating skills Completion of IEA or equivalent courses 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., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' 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. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US 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 *********************************************** Feel free to include a cover letter if you'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: ************************************************************************************************* 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. 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. THANK YOU! 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't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! 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 & 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&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here

Are you detail-oriented, highly professional, and passionate about delivering exceptional customer service? Join our dynamic team as a Claims Operations Examiner and play a vital role in our claims process. This early-career operational role offers an exciting opportunity to master core First Notice of Loss (FNOL) procedures while ensuring accurate, high-quality claim setups that make a real difference to our customers when they need us most. About the Role As a Claims Operations Examiner, you'll be at the heart of our claims processing operation, ensuring smooth transitions for claim handlers and consistency across all lines of business. You'll follow established procedures and regulatory requirements while developing expertise that will allow your responsibilities to grow over time. Key Responsibilities * Accurately process new claims and assign them to adjusters as appropriate * Prepare and deliver acknowledgment letters to insureds and brokers in a timely manner * Analyze and extract critical information from claim documents for system entry and coding * Ensure compliance by properly acquiring and handling all regulatory documents * Support and collaborate with the offshore transactional team as needed * Coordinate extensively with other departments for seamless operations * Process financial aspects of claims when applicable * Deliver personalized customer service tailored to unique client needs About the Team The Claims Operations USA & Canada team is a vital operational unit focused on new claim intake, financial processing, regulatory procedures, and coordinating between internal and external stakeholders. Our team serves as the critical first point of contact in the claims journey, ensuring accuracy and compliance while providing exceptional service to all parties involved in the claims process. About You You're a detail-oriented professional with excellent communication skills and a passion for customer service. You thrive in collaborative environments and can juggle multiple priorities while maintaining accuracy. Your ability to adapt quickly to changing situations makes you an ideal candidate for our dynamic claims environment. We are looking for candidates who meet these requirements: * Strong customer service skills with a demonstrable client-focused approach * Exceptional attention to detail and commitment to accuracy * Proven ability to prioritize multiple assignments and consistently meet deadlines * Experience collaborating effectively in team environments * Excellent verbal and written communication skills These are additional nice to haves: * Knowledge of the insurance industry, specifically in operations * Experience working with claims management systems or similar database applications * Agile mindset with a willingness to learn and improve continuously * Ability to adapt quickly in a dynamic and fast-paced industry * Previous experience in a customer service or administrative role The role will be located in our Kansas City, MO office. Our company has a hybrid work model where the expectation is that you will be in the office at least three days per week. The estimated base salary range for this position is $49,000 to $81,000. The specific salary offered for this, or any given role will take into account a number of factors including but not limited to job location, scope of role, qualifications, complexity/specialization/scarcity of talent, experience, education, and employer budget. At Swiss Re, we take a "total compensation approach" when making compensation decisions. This means that we consider all components of compensation in their totality (such as base pay, short-and long-term incentives, and benefits offered), in setting individual compensation. About Swiss Re Corporate Solutions Swiss Re is one of the world's leading providers of reinsurance, insurance and other forms of insurance-based risk transfer. We anticipate and manage risks, from natural catastrophes and climate change to cybercrime. Swiss Re Corporate Solutions is the commercial insurance arm of the Swiss Re Group. We offer innovative insurance solutions to large and midsized multinational corporations from our approximately 50 locations worldwide. We help clients mitigate their risk exposure, whilst our industry-leading claims service provides them with additional peace of mind. Our success depends on our ability to build an inclusive culture encouraging fresh perspectives and innovative thinking. Swiss Re Corporate Solutions embraces a workplace where everyone has equal opportunities to thrive and develop professionally regardless of their age, gender, race, ethnicity, gender identity and/or expression, sexual orientation, physical or mental ability, skillset, thought or other characteristics. In our inclusive and flexible environment everyone can bring their authentic selves to work and their passion for sustainability. If you are an experienced professional returning to the workforce after a career break, we encourage you to apply for open positions that match your skills and experience. Swiss Re is an equal opportunity employer. It is our practice to recruit, hire and promote without regard to race, religion, color, national origin, sex, disability, age, pregnancy, sexual orientations, marital status, military status, or any other characteristic protected by law. Decisions on employment are solely based on an individual's qualifications for the position being filled. During the recruitment process, reasonable accommodations for disabilities are available upon request. If contacted for an interview, please inform the Recruiter/HR Professional of the accommodation needed. Keywords: Reference Code: 136693 Nearest Major Market: Kansas City Job Segment: Operations Manager, Compliance, HR, Claims, Law, Operations, Legal, Human Resources, Insurance

Details Claims Examiner I - Commercial Auto Department: Property & Casualty Reports To: Claims Supervisor FLSA Status: Exempt in all state except California Job Grade: 9 Career Ladder: Next step in progression could include Claims Examiner II 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 a full-time Claims Examiner I to support our Property & Casualty department. Employees who live less than 26 miles from the San Antonio, TX, or Lake Mary, FL offices are required to work once a week in the office. The remaining days can be worked remotely if technical requirements are met, and the employee resides in a state Athens operates in (includes CA, CT, FL, GA, ID, IL, MA, NY, NC, NJ, OH, OK, OR, PA, SC, TN, TX, VA and WV). Athens Program Insurance Services is the centerpiece of P&C claims administration in the specialty programs marketplace. We are totally unique in that we focus only on commercial business specialization across multiple coverage lines. 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 through Friday at 37.5 hours per week. The Claims Examiner I is responsible for the timely investigation, evaluation and determination of settlement or denial of minor to moderate multi-line auto property and casualty claims. They will be handling claims from inception to closure. 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: Knowledge in the following areas: 1) claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge, 2) functional knowledge of law and insurance regulations in various jurisdictions, 3) demonstrated advanced verbal and written communications skills, 4) demonstrated analytical, decision making and negotiation skills. Investigate coverage, including evaluate insurance coverage problems and/or disputes Investigate, evaluate and determine settlement value or denial of liability for all claims Develop a measure of damage for each loss, establish and maintain appropriate reserves Document and manage claims (i.e.: record statements, update diaries, write reports) from inception to closure Ensure appropriateness of all payments Negotiate settlement of claim within individual authority ($15,000 unless otherwise noted) Maintain and update action plans for each claim May assign and coordinate with vendors, legal counsel, appraisers or experts as necessary Facilitate between claimants, clients, brokers and attorneys in resolution of liability claims Exchange information with clients, claimants, insurance brokers, inspectors, producers and account managers Provide customer service and support to insureds and claimants Assist in training of new employees Attend meetings and educational seminars for professional development Maintain required licenses 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 Must possess a license from your domiciled (state you live in or designated home state) state and a minimum of one license in any of the following states: NY, TX, or FL Additional State Adjuster License(s) may be required within 180 days Maintain licenses and continuing education requirements in all states Minimum of three years auto-claims handling experience, at least one-year commercial auto required Knowledge of property and casualty insurance policies Knowledge of auto insurance laws, codes, procedures, and liability concepts Proficiency in investigation and resolution of minor to medium level auto physical damage casualty claims Strong negotiation skills and ability to achieve optimal settlement results for clients. 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., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to be demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor. Athens' 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. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US 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 *********************************************** Feel free to include a cover letter if you'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: ************************************************************************************************* 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. 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. THANK YOU! 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't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! 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 & 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&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here

At the direction of the Claims Supervisor, Claims Manager, investigates, evaluates, disposes and settles moderately complex to complex/high exposure claims. Includes the investigation, evaluation and determination of coverage, compensability and responsibility and the setting of proper reserves. You will be working with the Alternative Dispute Resolution Program (ADR) which encompasses mostly City of Fresno Police Officers. However, you will also be working with other employees of the Fresno Police Department. This position requires considerable interaction with the City of Fresno, claimants, providers, claims examiners, ADR ombudsperson and other Tristar staff. Therefore, consistently being at work in the office or home office location as applicable, in a timely manner, is inherently required of this position. DUTIES AND RESPONSIBILITIES: Processes moderately complex to complex or high exposure claims consistent with clients' and corporate policies, procedures and “Best Practices” and in accordance with any statutory, regulatory and ethics requirements. Independently analyzes claim exposure, determines a proper plan of action to appropriately mitigate and settle/close the claim working within established level of authority. Interacts with injured workers, client contacts and attending Physician(s) to ensure awareness and understanding of the Workers' Compensation process, requirements and entitlements. Interacts with disability and leave examiners' for coordination of non occupational benefits. Prepares and issues notices in accordance with mandated requirements and regularly reviews and stays abreast of applicable laws, rules and regulations that may impact how claims are processed. Establishes and maintains proper reserving throughout the life of the claim. Identify subrogation potential and pursue the process for reimbursement. Complies with carrier excess reporting and threshold requirements. Coordinates medical treatment for injured workers and provides information to treating physician(s) regarding the employee's medical history, health issues and job requirements. Fully understands Medicare reporting requirements as they relate to a Workers' Compensation claim. Facilitates early RTW through temporary, transitional, alternate, or modified work. Manages all medical aspects of a claim file with a focus on RTW and end of treatment. Refers appropriate files for task management assignments to approved vendors for medical management, special investigative needs, conditional payments, etc. up to assigned authority. Monitors status and quality of work performed. Serves as a liaison between medical providers, employees, legal professionals, clients and vendors. Independently manages claims in litigation with regular and consistent communication with defense counsel to make recommendations and develop strategy. Enters and maintains accurate information in the claims management computer system. Clearly communicates concise action plans and present plans for moving the claim to resolution. Meets with clients to discuss on-going claims or review open claim inventory. Effectively controls expenses on all Workers' Compensation claims. Mentors first level WC Examiners. All other duties as assigned. EQUIPMENT OPERATED/USED: Computer, fax machine, copier, printer and other office equipment. SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire. Qualifications QUALIFICATIONS REQUIRED: Education: High School Diploma or GED required: Bachelor's degree in related field (strongly preferred) or equivalent combination of education and experience. Experience: Three (3) to five (5) years of Workers' Compensation Claims administration experience required working with self-insured and/or insured claims. Preferred Skills: Demonstrated experience working with complex, high exposure and litigated WC claims. Appropriately licensed and/or certified in all States in which claims are being handled. Multi-Jurisdiction experience is a (+). Bilingual Spanish is a (+) Able to work in a fast paced, high stress, changing environment. Strong analytical, critical thinking and problem solving skills required. Effective verbal and written communication skills required. Excellent planning, organizing and negotiation skills required. Attention to detail. Negotiation and interpretive skills necessary. Demonstrated knowledge of established claims strategy and mitigation techniques. Establishes and maintains effective working relationships with those contacted in the course of work. Proficiency with computers and technology - working knowledge of Microsoft Office application suite (MS Word, Excel, etc. and familiarity and experience using standard claims administration applications. Good interpersonal skills with an ability to work within a team environment. Able to effectively handle multiple priorities simultaneously. Works independently.

Please make sure that you complete all the questions and navigate to the end of the application to sign the application. This position is a hybrid This will be a permanent Floating Examiner position to cover open desks due to Vacations, Leaves of Absence, new business onboarding, increased pending inventories, Auditing, etc. At the Direction of the Claims Supervisor and/or Manager, under minimal supervision, manages all aspects of Workers' Compensation claims (complex, litigated, non-disabling) claims from inception to conclusion within established authority and guidelines. The position requires considerable interaction with clients, claimants, medical providers, Attorneys, vendors, nurses and Vocational Case Managers, and other TRISTAR staff. DUTIES AND RESPONSIBILITIES: Effectively manages a Temporary caseload of Workers' Compensation claim files, including very complex and litigated claims. * Initiates and conducts investigations in a timely manner. * Determines compensability of claims and administer benefits based upon state law and TRISTAR Best Practices for claim handling. * Manages medical treatment and medical billing, authorizing as appropriate. * Refers cases to outside defense counsel and participates in litigated matters. * Communicate with claimants, attorneys, providers and vendors regarding claims issues. * Work in an organized and proactive manner. * Computes and set reserves within Company guidelines. * Settles and/or finalize all claims and obtains authority as designated. * Maintains a diary system for case review and documents file to reflect the status and work being performed on the file, including a plan of action. * Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns. * Conducts file reviews as scheduled by the client and management.* Identify and review claims for Apportionment assignment. * Identify and investigate subrogation potential and pursue recovery.* Identify claim standard criteria for excess reporting and reimbursement.* Assist with State Audit and reporting responses.* Mentors less experienced Examiners Other duties as assigned and including claims management of other jurisdictional workers' comp claims. Adheres to all TRISTAR company policies and procedures. * Essential job function. EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment. SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire Qualifications QUALIFICATIONS REQUIRED: Education/Experience: Minimum five (5) or more years related experience; or equivalent combination of education and experience. Knowledge, Skills, and Abilities: Technical knowledge of statutory regulations and medical terminology. Analytical skills. Excellent written and verbal communication skills, including the ability to convey technical details to claimants, clients, and staff. Ability to interact with people at all levels in the business environment. Ability to independently and effectively manage very complex claims. Proficient in Word and Excel (preferred). Other Qualifications: California Self-Insurance Certificate Here are some of the benefits you can enjoy in this role: Medical, Dental, Vision Insurance. Life and Disability Insurance. 401(k) Plan Paid Holidays Paid Time Off. Referral bonus. Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements] MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORT a. Reoning development: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems, several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application. c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PHYSICAL EFFORT a. Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects Heavy work: a. Exerting up to 100 pounds of force occasionally b. Exerting up to 50 pounds of force frequently c. Exerting up to 20 pounds of force constantly to move objects Very heavy work: a. Exerting in excess of 100 pounds of force occasionally b. Exerting in excess of 50 pounds of force constantly to move objects c. Exerting in excess of 20 pounds of force constantly to move objects Visual requirements necessary to perform the job: Far vision: clarity of vision at 20 feet or more X Near vision: clarity of vision at 20 inches or less X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. X Kneeling: Bending legs at knee to come to a rest on knee or knees. X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time. X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals. X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles. X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. X Grasping: Applying pressure to an object with the fingers and palm. Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally 2. PHYSICAL EFFORT (cont.) FREQUENCY X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. Frequently Frequently Frequently 3. WORKING CONDITIONS Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITION ENVIRONMENTAL FACTOR NATURE/REASON OF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes Other (specify): Signatures: This job description has been approved by all levels of management: Human Resources: ____________________________Manager/Supervisor: _______________________________ The employee's signature below constitutes the employee's understanding of the mental and physical requirements, essential functions, and duties of the position. Employee____________________________________ Date_________________________

Please sign the application at the end. SIP required At the Direction of the Claims Supervisor and/or Manager - manages all aspects of complex and litigated indemnity claims from inception to conclusion within established authority and guidelines. This position requires considerable interaction with clients, claimants, Medical providers, Attorneys, vendors, Nurse and Vocational Case Managers and other TRISTAR staff. DUTIES AND RESPONSIBILITIES: Effectively manages a caseload of indemnity claim files, including very complex and litigated claims.* Initiates and conducts investigations in a timely manner.* Determines compensability of claims and administers benefits based upon state law and TRISTAR Best Practices for claim handling.* Manages medical treatment and medical billing, authorizing as appropriate.* Refers cases to outside defense counsel and participates in litigated matters.* Communicates with claimants, attorneys, providers, and vendors regarding claims issues.* Work in an organized and proactive manner.* Computes and sets reserves within Company guidelines.* Settles and/or finalizes all claims and obtains authority as designated.* Maintains diary system for case review and documents file to reflect the status and work being performed on the file, including a plan of action.* Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety-related concerns.* Conducts file reviews as scheduled by the client and management.* Identify and review claims for Apportionment assignment.* Identify and investigate subrogation potential and pursue recovery.* Identify claim standard criteria for excess reporting and reimbursement.* Assist with State Audit and reporting responses.* Mentors less experienced Examiners Other duties as assigned including claims management of other jurisdictional workers' comp claims. Adheres to all TRISTAR company policies and procedures.* * Essential job function. EQUIPMENT OPERATED/USED: Computer, 10-key, fax machine, copier, printer, and other office equipment. SPECIAL EQUIPMENT OR CLOTHING: Appropriate office attire Qualifications Education/Experience: Minimum five (5) or more years related experience; or equivalent combination of education and experience. HS diploma required, BS preferred Knowledge, Skills, and Abilities: Technical knowledge of statutory regulations and medical terminology. Analytical skills. Excellent written and verbal communication skills, including the ability to convey technical details to claimants, clients, and staff. Ability to interact with persons at all levels in the business environment. Ability to independently and effectively manage very complex claims. Proficient in Word and Excel (preferred). Other Qualifications: Licenses as required by Jurisdiction.. SIP required Here are some of the benefits you can enjoy in this role: Medical, Dental, Vision Insurance. Life and Disability Insurance. 401(k) Plan Paid Holidays Paid Time Off. Referral bonus. Mental and Physical Requirements: [see separate attachment for a copy of checklist of mental and physical requirements] MENTAL AND PHYSICAL REQUIREMENTS 1. MENTAL EFFORT a. Reasoning development:: Follow one- or two-step instructions; routine, repetitive task. Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables. Follow written, verbal, or diagrammatic instructions; several concrete variables. X Solve practical problems; variety of variables with limited standardization; interpret instructions. Logical or scientific thinking to solve problems; several abstract and concrete variables. Wide range of intellectual and practical problems; comprehend most obscure concepts. b. Mathematical development: Simple additional and subtraction; copying figures, counting, and recording. Add, subtract, multiply, and divide whole numbers. X Arithmetic calculations involving fractions, decimals, and percentages. Arithmetic, algebraic, and geometric calculations. Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination. Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application. c. Language development: Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing. Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction. Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants. X Ability to compose original correspondence, follow technical manuals, and have increased contact with people. Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data. 2. PHYSICAL EFFORT a. Physical activity required to perform the job: Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met. X Light work: a. Exerting up to 20 pounds of force occasionally b. Exerting up to 10 pounds frequently c. Exerting a negligible amount of force constantly to move objects (If the use of arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most of the time, the job is rated for Light Work). Medium work: a. Exerting up to 50 pounds of force occasionally b. Exerting up to 20 pounds of force frequently c. Exerting up to 10 pounds of force constantly to move objects Heavy work: a. Exerting up to 100 pounds of force occasionally b. Exerting up to 50 pounds of force frequently c. Exerting up to 20 pounds of force constantly to move objects Very heavy work: a. Exerting in excess of 100 pounds of force occasionally b. Exerting in excess of 50 pounds of force constantly to move objects c. Exerting in excess of 20 pounds of force constantly to move objects Visual requirements necessary to perform the job: Far vision: clarity of vision at 20 feet or more X Near vision: clarity of vision at 20 inches or less X Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are Color vision: ability to identify and distinguish colors Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point 2. PHYSICAL EFFORT (cont.) FREQUENCY c. Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally): Climbing: Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like, using feet and legs and/or hands and arms. Body agility is emphasized. This factor is important if the amount and kind of climbing required exceeds that required for ordinary locomotion. Balancing: Maintaining body equilibrium to prevent falling when walking, standing, or crouching on narrow, slippery, or erratically moving surfaces. This factor is important if the amount and kind of balancing exceeds that needed for ordinary locomotion and maintenance of body equilibrium. X Stooping: Bending body downward and forward by bending spine at the waist. This factor is important if it occurs to a considerable degree and requires full use of the lower extremities and back muscles. X Kneeling: Bending legs at knee to come to a rest on knee or knees. X Crouching: Bending the body downward and forward by bending legs and spine. Crawling: Moving about on hands and knees or hands and feet. X Reaching: Extending hand(s) and arm(s) in any direction. X Standing: Particularly for sustained periods of time. X Walking: Moving about on foot to accomplish tasks, particularly for long distances. X Pushing: Using upper extremities top press against something with steady force in order to thrust forward, downward, or outward. X Pulling: Using upper extremities to extent force in order to drag, haul, or tug objects in a sustained motion. Foot Motion: Using feet to push pedals. X Lifting: Raising objects from a lower to a higher position or moving objects horizontally from position to position. This factor is important if it occurs to a considerable degree and requires substantial use of the upper extremities and back muscles. X Fingering: Picking, pinching, typing, or otherwise working with fingers rather than with the whole hand or arm as in handling. X Grasping: Applying pressure to an object with the fingers and palm. Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Occasionally Frequently Frequently Occasionally 2. PHYSICAL EFFORT (cont.) FREQUENCY X Talking: Expressing or exchanging ideas by means of the spoken word. Those activities in which workers must convey detailed or important spoken instructions to other workers accurately, loudly, or quickly. X Hearing: Perceiving the nature of sounds with or without correction. Ability to receive detailed information through verbal communication, and to make fine discriminations in sound, such as when making find adjustments on machined parts. Feeling: Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips. X Repetitive Substantial movements (motions) of the wrists, hands, Motion: and/or fingers. Frequently Frequently Frequently 3. WORKING CONDITIONS Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure. WORKING CONDITION ENVIRONMENTAL FACTOR NATURE/REASON OF EXPOSURE FREQUENCY Dirt/Dust Noise Temperature extremes Dampness Vibrations Equipment movement hazard Chemicals/solvents Electrical shock Significant work pace/pressure Odors/Fumes Other (specify):

DETAILS Assistant Claims Examiner - Flex Department: Workers' Compensation 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 - Flex to support our Workers' 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 - 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 - 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. 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: Process new claims in compliance with client's Service Agreement Issue all indemnity payments and awards on time Process all approved provider bills timely Prepare objection letters to providers for medical bills; delayed, denied, lacking reports. 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. Contact injured worker at initial set up Send DWC notices timely Issue SJDB Notices timely Request Job Description from Employer Handle Medical Only claim files Calculate wage statements and adjust disability rates as required Keep diary for all delay dates and indemnity payments Documents file activity on computer Update information on computer, i.e., address changes, etc. Schedule appointments for AME, QME evaluations Send appointment letters, issue TD/mileage, send medical file Schedule interpreter for appointments, depositions, etc. Request Employer's Report, DWC-1, Doctor's First Report if needed Verify mileage and dates of treatment for reimbursement to claimant Subpoena records File and serve documents on attorneys, WCAB, doctors Serve PTP's with medical file and Duties of Treating Physician (9785) Request PD ratings from DEU Draft Stipulated Awards and C&R's Submit C&R, Stipulated Awards to WCAB for approval with documentation Process checks - stop payment, cancellations, void, journal payments Handle telephone calls for examiner as needed Complete penalty calculations and prepare penalty worksheets Complete MPN, HCO and/or EDI coding Complete referrals to investigators 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, attorneys, doctors, vendors, and other parties Provide updates of claims status to Senior Claims Examiners and Athens management Prepare professional, well written correspondence and other communications 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 Medical Only Adjuster designation required Continuing hours must be current Mathematical calculating skills Completion of IEA or equivalent courses 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., proven ability to research and analyze facts, identify issues, and make appropriate recommendations and solutions for resolution Ability to be trustworthy, dependable, and team-oriented for fellow employees and the organization Seeks to include innovative strategies and methods to provide a high level of commitment to service and results Ability to demonstrate care and concern for fellow team members and clients in a professional and friendly manner Acts with integrity in difficult or challenging situations and is a trustworthy, dependable contributor Athens' 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. Must be able to reliably commute to meetings and events as required by this position APPLY WITH US 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 *********************************************** Feel free to include a cover letter if you'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: ************************************************************************************************* 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. 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. THANK YOU! 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't forget to check out our website at ******************* as well as our LinkedIn, Glassdoor, and Facebook pages! 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 & 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&D, Long Term Care, Critical Care, Accidental, Hospital Indemnity, HSA & FSA options, 401k (and Roth), Company-Paid STD & LTD and more! Further information about our comprehensive benefits package may be found on our website at https://*******************/careers/why-work-here

Join Our Team as a Claims Processing Expert! Are you a data-driven marketer who thrives on turning insights into impactful strategies? We are looking for a Claims Processing Expert to analyze key performance metrics, optimize marketing campaigns, and drive data-backed decision-making. Why You'll Love This Role: 📊 Data-Driven Impact - Play a critical role in shaping marketing strategies through analytics. 🚀 Career Growth - Access professional development and leadership opportunities. ⏰ Work-Life Balance - Enjoy a flexible schedule with full-time opportunities. 💰 Competitive Compensation - Earn a stable income with performance-based incentives. Your Responsibilities: Analyze marketing campaign performance, customer behavior, and market trends. Develop and track key performance indicators (KPIs) to measure marketing effectiveness. Provide data-driven insights and recommendations to optimize marketing strategies. Work with cross-functional teams to ensure data accuracy and consistency. Utilize analytics tools (Google Analytics, Tableau, etc.) to generate reports and dashboards. A/B test campaigns and refine strategies based on data insights. What We're Looking For: Proven experience in marketing analytics, data analysis, or a related field. Proficiency in analytics tools such as Google Analytics, Tableau, or SQL. Strong analytical and problem-solving skills. Ability to translate complex data into actionable marketing strategies. Experience with digital marketing metrics, reporting, and performance optimization. Perks & Benefits: Professional development and continuous learning opportunities. Health insurance and retirement plans. Performance-based bonuses and recognition programs. Leadership growth and career advancement opportunities. 🚀 Ready to Turn Data into Growth? If you're passionate about leveraging data to drive marketing success, apply today! Join us and help shape data-driven marketing strategies that make an impact. Your journey as a Claims Processing Expert starts here-let's optimize for success together!

Join Our Dynamic Insurance Team - Unlock Your Potential! Are you ready to take control of your future and build a career in one of the most stable and lucrative industries? We are seeking driven individuals to join our thriving insurance team, where you'll receive top-tier training, support, and unlimited income potential. NOW HIRING: ✅ Licensed Life & Health Agents ✅ Unlicensed Individuals (We'll guide you through the licensing process!) We're looking for our next leaders-those who want to build a career or an impactful part-time income stream. Is This You? ✔ Willing to work hard and commit for long-term success? ✔ Ready to invest in yourself and your business? ✔ Self-motivated and disciplined, even when no one is watching? ✔ Coachable and eager to learn? ✔ Interested in a business that is both recession- and pandemic-proof? If you answered YES to any of these, keep reading! Why Choose Us? 💼 Work from anywhere - full-time or part-time, set your own schedule. 💰 Uncapped earning potential - Part-time: $40,000 - $60,000 /month | Full-time: $70,000 - $150,000+++/month. 📈 No cold calling - You'll only assist individuals who have already requested help. ❌ No sales quotas, no pressure, no pushy tactics. 🧑 🏫 World-class training & mentorship - Learn directly from top agents. 🎯 Daily pay from the insurance carriers you work with. 🎁 Bonuses & incentives - Earn commissions starting at 80% (most carriers) + salary 🏆 Ownership opportunities - Build your own agency (if desired). 🏥 Health insurance available for qualified agents. 🚀 This is your chance to take back control, build a rewarding career, and create real financial freedom. 👉 Apply today and start your journey in financial services! ( Results may vary. Your success depends on effort, skill, and commitment to training and sales systems. )