Job Type
Full-time
Description
Role Summary: As a Workers' Compensation Claims Adjuster II at AvonRisk, you'll independently manage a complex inventory of indemnity claims from intake through resolution, applying sound judgment, strong knowledge of applicable WC statutes, and a proactive approach to medical management, litigation, and recovery. You'll report to your unit Claims Supervisor and work across a diverse portfolio of self-insured client accounts.
Location & Work Arrangement: This is a hybrid position requiring three (3) days per week at your designated AvonRisk office. Candidates must be located within commuting distance of an AvonRisk office location.
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 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:$37.00 - $43.00 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
#LI-Hybrid
