Workers Compensation Claims Adjuster II
Key Skills for This Role
Full Job Posting
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 California Worker's Compensation claims adjusting experience with a Bachelor's degree, with demonstrated ability to independently manage indemnity claims through resolution.
5 years of California Worker's Compensation claims adjusting experience without a Bachelor's degree, with demonstrated ability to independently manage indemnity claims through resolution.
SIP designation preferred but not required; AvonRisk supports employees in obtaining required adjuster licensure where applicable.
Licenses & Certifications
Active adjuster license in applicable state(s) required.
Professional designations such as AIC, ARM, or WCCP a plus.
Technical & Subject Matter Skills
- Working knowledge of applicable state 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: $35.00 - $43.00
- 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
AvonRisk is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.
Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.
#LI-Hybrid
Requirements
- Working knowledge of applicable state 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: $35.00 - $43.00
- 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
About AvonRisk
Private national specialty risk manager and third-party administrator serving self-insured employers, public entities, carriers, and brokers.
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