Senior WC Claims Strategist – Remote/Hybrid

InterMed Cost Containment Services; Rocklin (CA); Hybrid; USD 95,000 - 97,000; Full time

Job summary

AvonRisk is seeking a senior Workers’ Compensation Claims Adjuster III to manage the most complex, high-exposure claims, including catastrophic injuries and multi-party litigation. You will provide technical guidance, supervise junior staff, and coordinate with clients, carriers, and experts to drive favorable outcomes.

Remote or hybrid work arrangement is possible depending on location. CA SIP certification is preferred for CA files; a comprehensive benefits package is included with a salary

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.
• CA SIP certificate required for CA files. (CA only)
• Professional designations such as AIC, ARM, WCCP, or CPCU a plus but not required.
• Deep knowledge of California WC statutes and multi-jurisdiction experience a plus.

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 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.
• Independently negotiate and finalize high-value settlements including C&R and Stipulated Awards; manage multi-lien resolution and coordinate with lien counsel and CMS as required.
• Serve as technical backup for the Claims Supervisor; mentor Adjuster I and II colleagues and support unit-wide quality review.

Skills

Complex claims handling

Catastrophic injury management

Litigation coordination

Subrogation

Mentoring junior adjusters

Education

Bachelor’s degree in related field

Job description

AvonRisk is seeking a senior Workers’ Compensation Claims Adjuster III to manage the most complex, high-exposure claims, including catastrophic injuries and multi-party litigation. You will provide technical guidance, supervise junior staff, and coordinate with clients, carriers, and experts to drive favorable outcomes.

Remote or hybrid work arrangement is possible depending on location. CA SIP certification is preferred for CA files; a comprehensive benefits package is included with a salary