Associate Quantitative Risk Analyst Jobs in Murrieta, CA

ABOUT US:Ethos Risk Services is a leading provider of workers' compensation medical management, investigations, and claims solutions, dedicated to helping clients make better decisions through industry expertise, innovation, and exceptional service. As we continue to grow, we're expanding our cost containment capabilities through Definiti, a national leader in medical bill review, pharmacy benefit management, PPO network solutions, and reimbursement services. Together, we're building a comprehensive suite of solutions that helps clients reduce costs, improve efficiency, and achieve better claim outcomes. JOB SUMMARY:Our dynamic Bill Review team is seeking a full-time Hearing Representative to represent our organization and clients throughout the California workers' compensation lien resolution process. This role is responsible for resolving complex lien disputes, negotiating settlements, preparing legal documentation, and supporting administrative hearings while partnering closely with providers, attorneys, claims professionals, and bill review teams.Our ideal candidate has experience in California workers' compensation, strong analytical and negotiation skills, and enjoys solving complex reimbursement challenges in a fast-paced environment. KEY RESPONSIBILITIES:Attend Hearings – Participate in California Workers' Compensation Appeals Board (WCAB) lien conferences, settlement conferences, status conferences, and lien trials while representing client interests. Represent Clients – Advocate on behalf of Ethos and its clients during lien proceedings, negotiations, and administrative hearings. Negotiate Settlements – Work directly with providers, attorneys, and hearing representatives to resolve disputed liens and achieve favorable settlement outcomes. Review & Resolve Appeals – Evaluate provider appeals, reconsideration requests, and disputed lien claims while identifying appropriate resolutions. Prepare Legal Documentation – Draft Minutes of Hearing, appeal responses, hearing exhibits, and other supporting legal documentation. Research Regulations – Interpret California workers' compensation statutes, fee schedules, regulations, and case law to support case strategy and compliance. Support Litigation – Assist attorneys with hearing preparation, case analysis, and litigation support activities. Perform Technical Bill Review – Analyze workers' compensation medical bills, reimbursement issues, and complex payment disputes. Manage Complex Cases – Maintain accurate documentation, prioritize multiple cases, and ensure deadlines are consistently met. Collaborate Across Teams – Partner with claims professionals, bill review operations, providers, attorneys, and internal stakeholders to deliver timely and effective claim resolutions. QUALIFICATIONS:Education: High school diploma or equivalent (required). Associate's degree or higher is preferred.Experience:Minimum of 2 to 5 years of experience in workers' compensation, legal assistant, paralegal, claims, hearing representative, lien resolution, litigation support, or related experience (required). Experience with California's workers' compensation lien procedure and regulations (required). Experience attending WCAB proceedings, negotiating liens, preparing hearing exhibits, responding to provider disputes, and handling appeals (preferred). Experience preparing legal exhibits and hearing documentation (preferred). Experience in Conduent Strataware software (preferred). Certifications: Certification in medical cording or medical terminology (preferred). Skills: Excellent negotiation and conflict resolution skills Strong written and verbal communication Ability to analyze medical billing, reimbursement, and regulatory issues Excellent organizational, time management, and prioritization skills WORKING CONDITIONS:This position offers flexible work arrangements, including hybrid or full on-site options, based on business needs and management approval. The office is located at 26445 Rancho Parkway Street, Lake Forest, CA 92630. Flexible start times are available between 6:00 a.m. and 9:00 a.m., with eligibility for a 9/80 alternate work schedule (every other Monday or Friday off) following successful completion of training, satisfactory performance, business needs, and management approval. Occasional travel and overnight stay may be required to attend California Workers' Compensation Appeals Board (WCAB) proceedings.  Ethos Risk Services and Definiti Comp Solutions is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic.
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