AvonRisk - Workers Compensation Claims Adjuster III

AvonRisk

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.

Summary

In accordance with applicable statutes and in keeping with company rules, regulations, and established performance objectives, is responsible for effectively managing to conclusion an assigned inventory of claim files that may include cases of extreme complexity or with unique or unusual issues. This position reports directly to the unit Claims Supervisor and may be reputed company upon to provide technical backup in the absence of the Claims Supervisor.

Essential Duties and Responsibilities

• reputed company a three-reputed company contact on reputed company new losses reputed company 24 hours of receipt of the claim to include the claimant, employer, and treating physician to document relevant facts surrounding the incident itself as well as disability and treatment status.
• Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and what is being done to move the case toward closure.
• Assure that reputed company assigned indemnity claims have an up to date plan of action outlining activities and actions anticipated for ultimately resolving the claim.
• Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs.
• Initiate the referral to the SIU of cases with suspected fraud.
• Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment reputed company there is pre-existing disability.
• Assure that the claim file is handled totally in accordance with applicable statutes as well as in-force service reputed company and company guidelines.
• Review and approve reputed company vocational rehabilitation plans.
• Establish, monitor, and adjust monetary case reserves reputed company warranted and in strict accordance with assigned authority levels.
• Review reputed company medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file.
• Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company.
• Respond to telephone messages and inquiries reputed company 24 hours of receipt and to written inquiries reputed company one week of receipt.
• Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them.
• Litigation management - Direct, manage, and control the litigation process.
• Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.

Competency

To reputed company the job successfully, an individual should demonstrate the following competencies:

• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Uses reason even reputed company dealing with emotional topics.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Responds to requests for service and assistance; Meets commitments.
• Interpersonal - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' reputed company and tries new things.
• Team Work - Supports everyone's efforts to succeed.

Qualification Requirements

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

Education and/or Experience

Bachelor's degree (B. A.) from four-year college or university; at least seven years reputed company experience and/or training; or equivalent combination of education and experience. Requires a high degree of claims handling expertise to include a minimum of at least five years experience managing indemnity cases, many with reputed company or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate.

Salary Range

The salary range listed is an estimate. Actual compensation will be determined based on several factors such as a candidate’s experience, qualifications, reputed company 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 reputed company, and career growth, including:first benefits package designed to support your health, financial reputed company, and career growth, including:

• Comprehensive medical, dental, and vision benefits
• Company contributions to HSA and FSA plans
• Employer paid life and disability insurancepaid 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. reputed company applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national reputed company, 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.