Athens Administrators
Senior Workers Compensation Claims Examiner - Texas
Athens Administrators, Granite Heights, Wisconsin, United States
Senior Claims Examiner - TX
Athens Administrators is seeking a full‑time Senior Claims Examiner to support our Workers’ Compensation department. The role requires weekly onsite presence in San Antonio, TX (one day per week) with remaining days remote if technical requirements are met. The schedule is Monday‑Friday, 37.5 hours per week with a flex option.
Position Summary The Senior Claims Examiner will manage workers’ compensation claims from inception to settlement and closure. Responsibilities include timely processing of claims, payment of benefits, medical treatment management, reserve setting, settlement negotiations, and liaison with employers, employees, doctors, attorneys, and vendors.
Primary Responsibilities
Process new claims in compliance with client Service Agreements.
Establish contact with employers to review issues and respond to inquiries from all stakeholders.
Set and maintain appropriate reserves; review legal correspondence and medical reports.
Evaluate and approve medical procedures and treatment, administer benefits, and ensure correct payment of benefits.
Investigate coverage, liability, and monetary value of claims; review medical and legal bills for appropriateness.
Discuss medical treatment appropriateness with case managers; determine compensability.
Monitor and assist litigation; negotiate settlement of claim, liens, rehabilitation plans, etc.
Prepare and present reports to clients; appropriately close claims.
Help resolve client billing and payment inquiries, investigate complaints from injured workers.
Document and code claim files in the system; maintain and update action plans within specified time frames.
Provide direction to Claims Assistants and Claims Technicians, assist with training, coaching, and mentoring.
Maintain customer service and support for clients and claimants; collaborate with attorneys on settlements and litigation strategies.
Authorize and negotiate cost of medical treatment and supplies; maintain internal communication with staff.
Prepare professional written correspondence and other communications.
Essential Position Requirements
High School Diploma or equivalent (GED) required. AA/AS or BA/BS preferred.
Texas 03 Workers’ Compensation license required; Texas 08 All Lines license preferred.
3+ years recent workers’ compensation claim handling experience required; 5+ years preferred.
Solid knowledge of workers’ compensation laws, policies, and procedures.
Completion of IEA or equivalent courses.
Proficiency in determining case value and negotiating settlements.
Understanding of medical and legal terminology; strong mathematical skills.
Well developed verbal and written communication skills; strong attention to detail.
Excellent organizational skills, ability to multi‑task, and quick typing accuracy.
Proficient in Microsoft Office Suite; ability to learn additional computer programs.
Reasoning, problem‑solving, and analytical skills; proven ability to research and analyze facts.
Trustworthy, dependable, team‑oriented; integrity in all situations.
Understanding of the importance of confidentiality for sensitive information.
Must be able to reliably commute to meetings and events as required.
Application We invite you to apply online at
https://www.athensadmin.com/careers/job-openings . Please submit your resume and any cover letter. All applications will be reviewed by our Corporate Recruitment team.
Equal Opportunity Statement Athens Administrators is an Equal Opportunity/Affirmative Action employer. We provide equal employment opportunities to all qualified applicants regardless of race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, or disability. We prohibit discrimination in all employment decisions and conditions.
Benefits Athens offers comprehensive benefits: Medical, Vision, Dental, Life/AD&D, Long‑Term Care, Critical Care, Accident, Hospital Indemnity, HSA & FSA options, 401(k) (and Roth), Company‑Paid STD & LTD, and more. Additional details are available at
https://www.athensadmin.com/careers/why-work-here .
#J-18808-Ljbffr
Position Summary The Senior Claims Examiner will manage workers’ compensation claims from inception to settlement and closure. Responsibilities include timely processing of claims, payment of benefits, medical treatment management, reserve setting, settlement negotiations, and liaison with employers, employees, doctors, attorneys, and vendors.
Primary Responsibilities
Process new claims in compliance with client Service Agreements.
Establish contact with employers to review issues and respond to inquiries from all stakeholders.
Set and maintain appropriate reserves; review legal correspondence and medical reports.
Evaluate and approve medical procedures and treatment, administer benefits, and ensure correct payment of benefits.
Investigate coverage, liability, and monetary value of claims; review medical and legal bills for appropriateness.
Discuss medical treatment appropriateness with case managers; determine compensability.
Monitor and assist litigation; negotiate settlement of claim, liens, rehabilitation plans, etc.
Prepare and present reports to clients; appropriately close claims.
Help resolve client billing and payment inquiries, investigate complaints from injured workers.
Document and code claim files in the system; maintain and update action plans within specified time frames.
Provide direction to Claims Assistants and Claims Technicians, assist with training, coaching, and mentoring.
Maintain customer service and support for clients and claimants; collaborate with attorneys on settlements and litigation strategies.
Authorize and negotiate cost of medical treatment and supplies; maintain internal communication with staff.
Prepare professional written correspondence and other communications.
Essential Position Requirements
High School Diploma or equivalent (GED) required. AA/AS or BA/BS preferred.
Texas 03 Workers’ Compensation license required; Texas 08 All Lines license preferred.
3+ years recent workers’ compensation claim handling experience required; 5+ years preferred.
Solid knowledge of workers’ compensation laws, policies, and procedures.
Completion of IEA or equivalent courses.
Proficiency in determining case value and negotiating settlements.
Understanding of medical and legal terminology; strong mathematical skills.
Well developed verbal and written communication skills; strong attention to detail.
Excellent organizational skills, ability to multi‑task, and quick typing accuracy.
Proficient in Microsoft Office Suite; ability to learn additional computer programs.
Reasoning, problem‑solving, and analytical skills; proven ability to research and analyze facts.
Trustworthy, dependable, team‑oriented; integrity in all situations.
Understanding of the importance of confidentiality for sensitive information.
Must be able to reliably commute to meetings and events as required.
Application We invite you to apply online at
https://www.athensadmin.com/careers/job-openings . Please submit your resume and any cover letter. All applications will be reviewed by our Corporate Recruitment team.
Equal Opportunity Statement Athens Administrators is an Equal Opportunity/Affirmative Action employer. We provide equal employment opportunities to all qualified applicants regardless of race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, or disability. We prohibit discrimination in all employment decisions and conditions.
Benefits Athens offers comprehensive benefits: Medical, Vision, Dental, Life/AD&D, Long‑Term Care, Critical Care, Accident, Hospital Indemnity, HSA & FSA options, 401(k) (and Roth), Company‑Paid STD & LTD, and more. Additional details are available at
https://www.athensadmin.com/careers/why-work-here .
#J-18808-Ljbffr