Claims Adjuster

Description

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 their careers 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.  

The Workers Compensation Claims Adjuster is responsible for managing all aspects of a workers compensation claim which includes determining compensability, verifying coverage, administering disability and medical benefits, skillfully negotiating claim resolutions, troubleshooting and assisting injured employees, employers and medical/legal professionals with any service needs throughout the lifespan of a claim.

Essential Functions

• Receives newly reported claims
• Maintains and updates claim notes throughout lifespan of claim
• Records claim information in electronic database
• Interviews claimants, insureds, medical professionals and witnesses to determine claim validity
• Communicates claim compensability decisions to claimant, employer and medical provider
• Sets appropriate reserves based on nature/extent of injury
• Calculates lost time wages, makes disability payments directly to claimants and diaries future payments as appropriate
• Orders independent medical examination as necessary and prepares all relevant documentation for physician review
• Maintains regular correspondence with claimants, insureds, and nurse case manager to include claim updates, medical appointments, or issues with disability payments
• Reviews and processes medical bills through third-party vendor for additional discount opportunities
• Aggressively collaborates with claimants and insureds to ensure early return-to-work is pursued
• Works in partnership with legal counsel to warrant that insured’s interests are protected on litigated claims which includes providing all relevant claim documentation needed for defense counsel to successfully defend claim and evaluate ultimate claim exposure.
• Attends settlement conferences, mediations, and hearings on behalf of the insurance company/insured.
• Reviews and approves defense attorney bills within authority
• Works with underwriting to help provide relevant information on losses for renewal rates as well as Risk Management to identify trends and may interact with agents for insureds on losses.
• Responds to State requests for health cost disputes, applications for hearings and penalty assessment letters.
• Identifies subrogation potential and pursues recovery
• Leads claim reviews with clients as requested
• Other duties as assigned

Requirements

Requirements

• 10 years of experience adjusting Workers Compensation Claims in California required
• SIP Certification required
• Bilingual (Spanish/English) required
• Must be current with CEU's
• Proficiency in entire Microsoft Office suite
• Knowledge of relevant workers compensation laws
• Strong grasp of medical terminology
• Familiarity with medical cases and how treatment typically progresses
• Excellent oral and written communication abilities
• Attention to detail and good organization skills
• Ability to negotiate issues and settlements
• Strong focus on customer service which includes timely response to requests/inquiries
• Ability to adapt to changing technologies and learn functionality of new equipment and systems
• Ability to establish and maintain effective working relationships with others

Salary Range:

$85,000-$105,000 annually

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. 

Benefits:

We take care of our people so they can take care of their work and their teams. AvonRisk offers a competitive, people first benefits package designed to support your health, financial security, and career growth, including: 

• 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 
• Learning and development opportunities that support real career advancement 
• Employee assistance resources and a supportive culture that values balance and wellbeing 

We’re 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. 

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