Senior Workers' Compensation Claims Specialist

Position Title: Senior Claims Specialist Department: Workers Compensation Reports To: Claims Supervisor FLSA Status: Exempt Job Grade: 12 Career Ladder: Opportunities for advancement to Lead Senior Claims Specialist or Claims Supervisor. At Athens Administrators, we are proud of our long-standing reputation as leaders in claims administration since 1976. We prioritize a dynamic workplace where employees can flourish and feel valued as part of a recognized Best Place to Work. Join our supportive and inclusive team and take the next step in your professional journey in Workers' Compensation, Property & Casualty, Program Business, and Managed Care. Position Summary: We are seeking a full-time Senior Claims Specialist to enhance our workers' compensation team. Employees residing within 26 miles of our San Antonio, TX office are expected to work one day a week onsite, with remote work available on other days. Our office operates Monday through Friday from 7:30 a.m. to 5:30 p.m. local time, with a flexible schedule option. The Senior Claims Specialist will manage workers' compensation claims from start to finish, ensuring timely processing and settlement, directing medical treatment, setting reserves, and negotiating settlements. Primary Responsibilities: Process new claims according to client service agreements. Establish contact with employers to address issues and inquiries. Respond to communications from employers, employees, medical professionals, and legal parties. Set and maintain appropriate reserves for claims. Analyze legal correspondence and medical reports. Evaluate and approve medical procedures and treatment plans. Administer benefits while ensuring all payments are appropriate. Investigate claim coverage, liability, and monetary considerations. Review medical and legal billing for accuracy. Consult with medical case managers regarding treatment appropriateness. Determine claim compensability. Oversee and assist with litigation when necessary. Negotiate settlement terms for claims, liens, rehabilitation plans, etc. Prepare and deliver reports to clients regarding claims status. Help with client billing and payment queries. Address concerns raised by injured workers. Document and maintain accurate records in the claims system. Update action plans within targeted deadlines. Guide Claims Assistants and Technicians, providing training and mentorship. Engage with all relevant stakeholders to ensure effective communication. Deliver exceptional customer service to clients and claimants. Collaborate with attorneys on settlement drafts and litigation approaches. Authorize and negotiate costs related to medical care and supplies. Maintain positive internal communication with staff members. Compose clear and professional correspondence. Essential Position Requirements: High School Diploma or equivalent (GED) is required; AA/AS or BA/BS is preferred. Must hold a Texas 03 Workers Compensation license; 08 All Lines License is preferred. Minimum of 3 years of recent workers' compensation claims experience is required; 5+ years preferred. In-depth knowledge of workers' compensation laws, policies, and procedures. Completion of relevant training courses (IEA or similar) is preferred. Strong skills in assessing case values and negotiating settlements. Familiarity with medical and legal terminology is essential. Mathematical computation proficiency is necessary. Excellent verbal and written communication skills with a strong attention to detail. Outstanding organizational skills and the ability to manage multiple tasks. Proficient typing skills for extended periods. Competent in Microsoft Office Suite and able to learn additional software. Strong reasoning, problem-solving, and analytical abilities. Demonstrated reliability and a team-oriented approach. Creative thinker who enhances service quality and results. Professional demeanor with a caring attitude towards colleagues and clients. Integrity and trustworthiness in all scenarios, especially when managing sensitive information. Ability to commute reliably to meetings and events as needed. Apply With Us: We are eager to learn more about you! If you align with our core values of integrity, commitment to service, and a supportive culture, we encourage you to apply. Please submit your resume and application through our website. We appreciate the effort you dedicate to your job application. Athens Administrators is an Equal Opportunity/Affirmative Action employer. We value diversity and provide equal employment opportunities to all qualified candidates without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. Thank you for considering a career with Athens Administrators! We offer competitive compensation and a comprehensive benefits package, including Medical, Vision, Dental, Life, 401k, and more. For full details about our benefits, please visit our website.

Created: 2026-03-10