Senior Workers' Comp Claims Adjuster

AvonRisk; Rocklin (CA); On-site; USD 90,000 - 100,000; Full time

Benefits offered by this job

Medical, Dental, Vision

HSA/FSA contributions

Life and Disability Insurance

401(k) with match

PTO & Holidays

Learning & Development

Employee assistance program

Job summary

AvonRisk is seeking a claims professional to manage an assigned inventory of claim files through resolution, reporting to the unit Claims Supervisor. The role involves handling complex or high-potential subrogation and legal issues in compliance with applicable statutes.

You will document case facts, develop action plans, coordinate with medical case managers to maximize early return to work, and ensure accurate billing and reserves while maintaining professional client service.

Qualifications

• Bachelor's degree plus seven years related experience and SIP certificate.
• Experience managing indemnity claims, subrogation, rehabilitation, medical management, and legal issues.
• Knowledge of California workers' compensation statutes and rules.

Responsibilities

• Manage an assigned inventory of claim files to resolution with timely updates.
• Document case facts and actions for compensability, disability payments, and vendor usage.
• Develop and approve plans of action for indemnity claims and subrogation efforts.
• Collaborate with medical case managers to maximize early return to work.
• Refer suspected fraud to SIU and oversee litigation processes.

Skills

Problem Solving

Customer Service

Interpersonal

Team Work

Education

Bachelor's degree in related field

SIP certification

Job description

AvonRisk is seeking a claims professional to manage an assigned inventory of claim files through resolution, reporting to the unit Claims Supervisor. The role involves handling complex or high-potential subrogation and legal issues in compliance with applicable statutes.

You will document case facts, develop action plans, coordinate with medical case managers to maximize early return to work, and ensure accurate billing and reserves while maintaining professional client service.