Hybrid: Senior Workers' Comp Claims Adjuster

AvonRisk; Glendale (CA); Hybrid; USD 41,000 - 55,000; Full time

Benefits offered by this job

Hybrid work

Office in Glendale/Orange

Job summary

AvonRisk, a leading self-insured risk manager, seeks a Claims Specialist to manage an assigned inventory of files with a focus on timely resolution. You will contact claimants, employers, and medical providers within 24 hours and gather evidence to determine compensability and benefit needs.

You will collaborate with medical case managers to support early return to work, pursue subrogation where possible, and ensure file actions comply with laws and contracts.

Qualifications

• Bachelor’s degree preferred.
• 3–5 years related experience & training (5 years without SIP certificate).

Responsibilities

• Manage an assigned inventory of claim files to conclusion.
• Perform three-point contact with claimants, employers, and doctors within 24 hours.
• Gather evidence to establish compensability, disability, and payments.
• Maintain up-to-date plans of action for indemnity claims.
• Collaborate with medical case managers to enable early return to work.
• Refer suspected fraud cases to SIU and pursue subrogation when applicable.
• Ensure files comply with statutes, contracts, and company guidelines.
• Review vocational rehabilitation plans and monitor reserves.
• Review medical bills for appropriateness before referral for payment.

Skills

Problem Solving

Customer Service

Interpersonal

Team Work

Education

Bachelor’s degree preferred

Job description

AvonRisk, a leading self-insured risk manager, seeks a Claims Specialist to manage an assigned inventory of files with a focus on timely resolution. You will contact claimants, employers, and medical providers within 24 hours and gather evidence to determine compensability and benefit needs.

You will collaborate with medical case managers to support early return to work, pursue subrogation where possible, and ensure file actions comply with laws and contracts.