Workers Compensation Claims Adjuster III

Workers' Compensation Claims Adjuster III

AvonRisk is the nation's leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers' compensation, liability, managed care, and risk management across 32 states. With nearly 700 professionals and brands including Intercare, InterMed, George Hills, and AS&G Claims Administration, we're a people-focused, operations-driven organization that prioritizes reasonable caseloads, strong training, collaborative teams, and expert support.

We invest in tools and workflows that reduce friction—not increase volume—and create real career paths for professionals who want to grow or move into leadership. At AvonRisk, you're part of a team that values good judgment, curiosity, and accountability, and gives you the support to succeed.

Location & Work Arrangement: Remote or hybrid depending on candidate location.

Essential Duties & Responsibilities

Complex Claims Investigation & Compensability

• Perform three-point contact on all new losses and apply heightened scrutiny to complex, catastrophic, and high-exposure cases; maintain detailed plans of action with strategic resolution planning on all assigned indemnity files.
• Identify fraud indicators and refer to SIU with advanced pattern recognition; gather and document case facts on files involving multi-party liability, catastrophic injury, significant subrogation potential, or novel legal issues.

Medical Management, RTW & Vocational Rehabilitation

• Lead medical management on catastrophic and high-complexity claims including directing specialists, coordinating life care planners, directing UR and IMEs, and managing PTD cases.
• Partner with case managers to maximize early RTW; review medical bills for appropriateness on high-cost and unusual treatment patterns.

Permanent Disability, Reserving & Financial Stewardship

• Lead PD rating on complex cases including significant apportionment, overlapping injuries, and disputed ratings; establish and adjust reserves on high-exposure files with precision and clear documented justification.
• Ensure status reports are submitted in compliance with the reporting timelines and formats outlined in individual client instructions.

Litigation Management

• Independently direct the full litigation process on the unit's most complex files including selecting defense counsel, setting strategy, retaining experts, managing legal spend, and preparing for trial.
• Lead mediations, settlement conferences, and arbitrations; make or recommend high-value settlement authority decisions in coordination with the Claims Supervisor and client.

Settlements, Lien Resolution & Recovery

• Independently negotiate and finalize high-value settlements including C&R and Stipulated Awards; manage multi-lien resolution (MSA, Medi-Cal, provider, attorney liens) and coordinate with lien counsel and CMS as required.
• Aggressively pursue subrogation, multi-defendant contribution, and apportionment recovery; coordinate with recovery vendors and outside subrogation counsel on high-value opportunities.

Technical Leadership & Supervisory Backup

• Serve as technical backup for the Claims Supervisor; provide guidance on complex decisions, reserve adequacy, and escalated client issues; mentor Adjuster I and II colleagues and support unit-wide quality review.
• Serve as a senior point of contact for key client accounts on complex or escalated matters; maintain client and carrier relationships with professionalism and technical authority.

Professionalism & Communication

• Maintain proactive, transparent communication with all stakeholders; respond within required timeframes and project a professional, expert image in all interactions.

Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Qualifications:

Education & Experience

• Minimum 7 years of WC claims experience including at least 5 years of independent indemnity management with expertise in complex, high-exposure, and litigated files; OR
• Bachelor's degree and a minimum of 5 years of WC indemnity experience at an independent level; OR equivalent combination.
• Comprehensive knowledge of public entity liability claims including JPAs, self-insured programs, and pooled insurance arrangements.

Licenses & Certifications

• Active adjuster license in applicable state(s) required; multi-state preferred.
• CA SIP certificate required for CA files. (CA only)
• Professional designations such as AIC, ARM, WCCP, or CPCU a plus but not required.

Technical & Subject Matter Expertise

• Deep expertise in applicable state WC statutes; California statute mastery strongly preferred. Multi-jurisdiction experience highly valued.
• Direct experience working within one or more claims administration or claims processing platforms commonly used in worker's compensation/insurance claims handling.
• Demonstrated experience directing complex litigation through mediation, settlement conference, and trial preparation; advanced knowledge of PD rating, MSA requirements, and multi-party lien resolution.
• Experience with catastrophic injury management and life care planning coordination; familiarity with claims management platforms; proficiency in Microsoft Office.

Leadership & Interpersonal Skills

• Demonstrated ability to mentor junior adjusters and serve as a supervisory backup or senior technical resource.
• Strong client relationship management skills; experience handling escalated concerns at a senior level.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.

Compensation: Salary Range: $98,000.00 - $102,000.00

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:

• 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.