Senior WC Claims Adjuster — Complex & Litigation

InterMed Cost Containment Services; Rocklin (CA); On-site; USD 55,000 - 69,000; Full time

Benefits offered by this job

Medical, dental, and vision benefits

HSA/FSA plans

Employer-paid life and disability

401(k) with company match

PTO and holidays

Job summary

AvonRisk is seeking a Workers’ Compensation Claims Adjuster III in Rocklin, CA to manage the most complex, high‑exposure claims, including catastrophic injuries and multi‑party litigation. You will provide technical guidance, supervise backup, and serve as a senior resource for clients, carriers, and colleagues.

You will lead investigations, medical management, PD rating, litigation, and settlements, while pursuing subrogation and coordinating with lien and CMS teams.

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.
• 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.

Responsibilities

• 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.
• 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.
• 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.
• 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.
• 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.
• 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.

Education

Bachelor’s degree in relevant field

Job description

AvonRisk is seeking a Workers’ Compensation Claims Adjuster III in Rocklin, CA to manage the most complex, high‑exposure claims, including catastrophic injuries and multi‑party litigation. You will provide technical guidance, supervise backup, and serve as a senior resource for clients, carriers, and colleagues.

You will lead investigations, medical management, PD rating, litigation, and settlements, while pursuing subrogation and coordinating with lien and CMS teams.