Worker's Compensation Claims Adjuster II

Role Summary

Location & Work Arrangement

• Position is approved for remote work, candidates must be based in Texas with preference for Austin area.

Essential Duties & Responsibilities

• Claims Investigation & Compensability:
• Perform three-point contact within 24 hours on all new losses; thoroughly gather and analyze case facts, assess compensability, and maintain current plans of action on all assigned indemnity files.
• Identify and refer fraud indicators to the SIU; assure all claims are handled in accordance with applicable statutes, service contracts, and company guidelines.
• Medical Management:
• Direct medical care throughout the claim lifecycle including treatment authorization, maintaining medical control, UR and IME direction, and VR plan review; partner with case managers to maximize early return-to-work.
• Identify and rate permanent disability (PD) in accordance with applicable state guidelines; incorporate PD findings into reserve and settlement strategy.
• Reserving & Reporting:
• Establish, monitor, and adjust case reserves within assigned authority levels as facts develop; prepare 90-day carrier status reports with accuracy and strategic clarity.
• Litigation Management:
• Direct defense counsel, set litigation strategy, manage legal budgets, and drive litigated files toward efficient resolution; attend mediations and settlement conferences and make settlement authority decisions.
• Settlements & Recovery:
• Negotiate and finalize claim settlements including lien resolution (Medicare, Medi-Cal, provider, attorney liens) in alignment with client authority.
• Aggressively pursue subrogation from culpable third parties, multi-defendant contributions, and apportionment on pre-existing disability cases.
• Professionalism & Communication:
• Respond to inquiries within required timeframes; maintain proactive communication with injured workers, employers, carriers, counsel, and vendors throughout the life of each claim.
• Requirements

Qualifications

• Education & Experience:
• Minimum of 3 years of Texas Worker's Compensation claims adjusting experience with a Bachelor's degree, with demonstrated ability to independently manage indemnity claims through resolution.
• 5 years of Texas Worker's Compensation claims adjusting experience without a Bachelor's degree, with demonstrated ability to independently manage indemnity claims through resolution..
• Licenses & Certifications:
• Active Texas Worker's Comp or all lines license required; multi-state preferred.
• Professional designations such as AIC, ARM, or WCCP a plus.
• Technical & Subject Matter Skills:
• Working knowledge of Texas WC statutes; experience directing defense counsel and managing litigated claims.
• Familiarity with claims management platforms; proficiency in Microsoft Office; ability to read and interpret medical records and IME reports.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.

Compensation

• Salary Range: $28.00-$36.00 per hour
• The salary range listed is an estimate. Actual compensation will be determined based on several factors such as a candidate’s experience, qualifications, skill set, and work location. Position is eligible for AvonRisk’s full benefits package.

Benefits

• AvonRisk offers a competitive, people-first benefits package:
• Comprehensive medical, dental, and vision benefits
• Company contributions to HSA and FSA plans
• Employer-paid life and disability insurance
• 401(k) with company match
• Paid time off (PTO) and company-paid holidays
• Employee assistance resources and a supportive culture that values balance and wellbeing

Equal Opportunity Employer