Senior Claims Adjuster III - Complex & Subrogation

Intercare Holdings, Inc.; Glendale, Northern (CA, KY); Hybrid; USD 83,000 - 104,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

HSA/FSA contributions

Life and disability insurance

401(k) with company match

PTO and holidays

Job summary

AvonRisk is seeking a Claims professional to manage an assigned inventory of claims to resolution in a regulated environment. You will document facts, determine compensability and disability needs, and work closely with medical case managers to optimize outcomes.

Responsibilities include establishing action plans for indemnity claims, pursuing fraud referrals, and coordinating with litigation teams. A strong background in California workers’ compensation law is essential.

Qualifications

• Bachelor's degree and SIP certificate required.
• Minimum seven years related experience and/or training; claims handling expertise.

Responsibilities

• Manage a portfolio of claim files to conclusion, including complex cases.
• Document case facts and relevant information for compensability, disability payments, and expenses.
• Maintain up-to-date plan of action for indemnity claims and pursue early return-to-work opportunities.
• Initiate referrals to SIU for suspected fraud and pursue subrogation when applicable.
• Oversee medical bills review and coordinate with medical case management and litigation teams.

Education

Bachelor's degree (B.A.) from four-year college or university; SIP certificate

Tools

Labor Code knowledge (CA)

Job description

AvonRisk is seeking a Claims professional to manage an assigned inventory of claims to resolution in a regulated environment. You will document facts, determine compensability and disability needs, and work closely with medical case managers to optimize outcomes.

Responsibilities include establishing action plans for indemnity claims, pursuing fraud referrals, and coordinating with litigation teams. A strong background in California workers’ compensation law is essential.