[Hiring] Workers Compensation Claims Adjuster III @AvonRisk

Role Description

As a Workers’ Compensation Claims Adjuster III at AvonRisk, you are a senior technical expert trusted with the organization’s most complex, high-exposure, and strategically sensitive claims—including catastrophic injuries, multi-party litigation, and cases with novel legal or medical challenges. You provide technical guidance and supervisory backup to your unit and serve as a senior resource for clients, carriers, and colleagues.

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.

Qualifications

• 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.
• 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.
• 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.
• 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.

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.

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