Senior Workers’ Comp Claims Adjuster

InterMed Cost Containment Services; Orange (CA); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Medical benefits

Dental & Vision

HSA/FSA

Life and disability insurance

401(k) with match

PTO & holidays

Career development

Employee assistance

Job summary

AvonRisk is the nation’s leading specialty risk manager for self‑insured organizations, uniting leaders in workers’ compensation, liability, managed care, and risk management across 32 states.

The role reports directly to the unit Claims Supervisor and may provide technical backup in the absence of the Supervisor. You will manage an assigned inventory of claim files through closure, including complex or unusual issues.

Qualifications

• Bachelor's degree or higher with seven years of related experience.
• Equivalent combination of education and experience considered.
• Minimum five years indemnity case management with subrogation/rehabilitation/medical/legal issues and SIP.

Responsibilities

• Perform a three-point contact on all new losses within 24 hours of receipt to document facts and status.
• Document ongoing case facts for compensability, disability payments, and case progression toward closure.
• Maintain up-to-date action plans for indemnity claims and expected resolutions.
• Partner with medical case managers to maximize early return-to-work and reduce costs.
• Refer suspected fraud cases to SIU and pursue subrogation with third parties.
• Review medical bills for appropriateness before referral to InterMed for payment.

Skills

Problem Solving

Customer Service

Interpersonal

Team Work

Education

Bachelor's degree

Seven years experience

SIP certificate

Job description

AvonRisk is the nation’s leading specialty risk manager for self‑insured organizations, uniting leaders in workers’ compensation, liability, managed care, and risk management across 32 states.

The role reports directly to the unit Claims Supervisor and may provide technical backup in the absence of the Supervisor. You will manage an assigned inventory of claim files through closure, including complex or unusual issues.