Workers Compensation Adjuster

InterMed Cost Containment Services; Fully; On-site; CHF 70,000 - 78,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

HSA contributions

401(k) match

PTO & holidays

Job summary

AvonRisk is seeking a Workers' Compensation Claims Adjuster to manage all aspects of state Act workers' compensation claims, including determining compensability, administering benefits, negotiating resolutions, and supporting claimants, employers, and medical/legal professionals throughout the claim lifecycle.

You will interview claimants, maintain records, set reserves, coordinate medical exams, and collaborate with legal counsel and underwriters to ensure proper handling and timely reporting

Qualifications

• 5+ years experience handling CT, DE, MD, CA, NJ, PA, RI Workers Compensation claims and multi-state Adjuster license.
• Experience in, and hold a current adjusters license to handle WC claims in CT, DE, MD, CA, NJ, PA, RI - preferred
• High School education

Responsibilities

• Receives newly reported claims.
• Determines coverage under the State WC Act, and any exposure to LHWCA.
• 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. Diaries future payments as appropriate.
• Reports all mandatory claims data directly to State entities within required timeframes.
• Orders independent medical examination as necessary and prepares all relevant documentation for physician review.
• Maintains regular correspondence with claimants, insureds, clients, and nurse case manager to include claim updates, medical appointments, or issues with disability payments.
• Reviews and processes medical bills for additional discount opportunities.
• Aggressively collaborates with claimants, clients 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.
• Attend settlement conferences, mediations, and hearings on behalf of the insurance company
• 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.
• 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

Skills

Microsoft Office

Workers' comp laws

Medical terminology

Communication skills

Attention to detail

Negotiation

Customer service

Relationship building

Adaptability

Education

High School diploma

Multi-state adjuster license

5+ years WC claims experience

Job 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.

Job Type

Full-time

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.

Job Summary

The Workers Compensation Claims Adjuster is responsible for managing all aspects of a State Act 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
• Determines coverage under the State WC Act, and any exposure to LHWCA
• 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. Diaries future payments as appropriate.
• Reports all mandatory claims data directly to State entities within required timeframes
• Orders independent medical examination as necessary and prepares all relevant documentation for physician review
• Maintains regular correspondence with claimants, insureds, clients, and nurse case manager to include claim updates, medical appointments, or issues with disability payments.
• Reviews and processes medical bills for additional discount opportunities
• Aggressively collaborates with claimants, clients 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. This includes providing all relevant claim documentation needed for defense counsel to successfully defend claim and evaluate ultimate claim exposure.
• Attend settlement conferences, mediations, and hearings on behalf of the insurance company
• 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. Also 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

Knowledge, Skills and Abilities

• 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 professional 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

Required Education And Experience

• 5+ years experience handling CT, DE, MD, CA, NJ, PA, RI Workers Compensation claims and multi-state Adjuster license.
• Experience in, and hold a current adjusters license to handle WC claims in CT, DE, MD, CA, NJ, PA, RI - preferred
• High School education

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

Compensation

Salary Range: $85,000-$95,000 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. 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.