Compliance Specialist - Claims

ATHENS POSITION DETAILS

Position Title:

Compliance Specialist I

Department:

Shared Services

Reports To:

Audit and Compliance Supervisor

FLSA Status:

Non-Exempt in CA, Exempt in other states

Job Grade:

10

Career Ladder:

Next step in progression could include Compliance Specialist 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 Compliance Specialist I to support our Operations department. 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. Day determined by 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 for 37.5 hours a week. The primary responsibility of this position is to ensure that the processes and procedures of the Claims Department meet overall quality expectations and are in compliance with state and federal regulations and customer requirements.

This position will participate in the Operations Team’s goal of meeting Athens' compliance standards. This will be accomplished by ensuring that the claims system is set up appropriately, troubleshooting errors, tracking required training hours, and working on projects as assigned. This position will also work with claims staff, auditors, the Corporate Trainer, and management to organize and coordinate training programs to educate the staff, improve quality, reduce errors, and eliminate inconsistencies across the department.

The Compliance Specialist will oversee the examiner training compliance process to ensure that Athens remains in compliance with all applicable regulations and guidelines. Additionally, they will oversee the Annual Report and Interim Report process for all clients to ensure accurate incident reporting and timely submission to the state.

This position will work closely with the Compliance Specialist II and the Audit and Compliance Supervisor on SCHIP reporting, FROI/SROI compliance, and adherence to SOC standards and requirements and will also assist with the review and coordination of responses to requests for information and data from carriers, clients, and external auditors.

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:

Compliance Responsibilities

• Work with strategic business partners and vendors to ensure adherence to client and Athens guidelines and programs
• Complete Annual Reports
• Ensure Athens’ compliance with jurisdictional training and licensing requirements
• Obtain, prepare and/or provide required data and reports to carriers and clients
• Foster working relationships with carriers, state regulatory bodies, Athens management, and other Athens business groups in furtherance of Athens compliance efforts
• Complete special projects assigned to assist the organization in solving compliance problems and meeting compliance goals
• Exhibit a thorough understanding of industry standard claims processing guidelines
  
  
  

Claims System Administration Duties

• Set up and test new system users and troubleshoot and respond to requests for assistance from internal and external users
• Investigate and research claims system errors and issues, providing solutions when possible and coordinating additional assistance from other departments when needed
• Create and update letters, templates, notepads, forms, etc. in the claims system
• Provide systems-related technical assistance to the claims staff
• Assist with the development of claims processing improvement efforts
• Run reports, prepare spreadsheets and presentations
  
  
  

Training Tracking Duties

• Track all training hours to ensure that all attendees receive the necessary credit
• Conduct or coordinate and schedule training for clients and Athens staff on a variety of systems
• Utilize established training guides, curriculum, and materials. Update and develop new training materials as needed
• Assist with the development and administration of the Learning Management System
• Respond to and assist in the resolution of issues brought to Operations by internal users at all levels
• Work closely with other departments to ensure the accuracy of coordinated delivery of services
• Proactively initiate the creation of efficiencies
• Provide technical assistance on special projects
• Accept and perform other duties as assigned with reasonable independence
  
  
  

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 of either Workers’ Compensation or Property & Casualty claims handling strongly preferred
• Excellent written and verbal communication skills, including ability to convey technical details
• Must have proven ability to effectively communicate with executives, legal teams, and auditors
• Ability to think and act quickly and able to work under pressure
• Strong attention to detail and the ability to research and resolve problems
• Ability to work independently, organize, and prioritize work assignments
• Possession of independent decision-making skills and demonstrated initiative to resolve issues
• Ability to exercise good judgment and handle a fast-paced environment
• Able to assess and coordinate departmental workflows effectively
• Seeks to include innovative strategies and methods to provide a high level of commitment to service and results
• Ability to train using independently created instructional materials
• Prior experience with training preferred
• Must be able to take broad directives and follow through with appropriate action
• Implement ongoing quality improvement processes
• 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.
  
  

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 http://www.athensadmin.com/careers/job-openings 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: https://dcba.lacounty.gov/wp-content/uploads/2024/08/FCOE-Official-Notice-Eng-Final-8.30.2024.pdf.

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 www.athensadmin.com 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://www.athensadmin.com/careers/why-work-here