Senior Workers' Comp Claims Adjuster II - Hybrid

AvonRisk; Glendale (CA); Hybrid; USD 106,020,000 - 123,213,000; Full time

Job summary

AvonRisk, the nation’s leading specialty risk manager for self-insured organizations, seeks a Workers’ Compensation Claims Adjuster II in California. You will independently manage a complex indemnity claims portfolio from intake to resolution, applying sound judgment and knowledge of WC statutes while coordinating medical management and recovery strategies.

This hybrid role requires three days per week at a local AvonRisk office and proximity to an AvonRisk location.

Qualifications

• Minimum of 3 years of California Worker's Compensation claims adjusting experience with a Bachelor's degree, with demonstrated ability to independently manage indemnity claims through resolution.
• 5 years of California Worker's Compensation claims adjusting experience without a Bachelor's degree, with demonstrated ability to independently manage indemnity claims through resolution.
• SIP designation preferred but not required; AvonRisk supports employees in obtaining required adjuster licensure where applicable.

Responsibilities

• Perform three-point contact within 24 hours on all new losses; thoroughly gather and analyze case facts, assess compensability, and maintain current plans of action on all assigned indemnity files.
• Identify and refer fraud indicators to the SIU; assure all claims are handled in accordance with applicable statutes, service contracts, and company guidelines.
• Direct medical care throughout the claim lifecycle including treatment authorization, maintaining medical control, UR and IME direction, and VR plan review; partner with case managers to maximize early return-to-work.
• Identify and rate permanent disability (PD) in accordance with applicable state guidelines; incorporate PD findings into reserve and settlement strategy.
• Establish, monitor, and adjust case reserves within assigned authority levels as facts develop; prepare 90-day carrier status reports with accuracy and strategic clarity.
• Direct defense counsel, set litigation strategy, manage legal budgets, and drive litigated files toward efficient resolution; attend mediations and settlement conferences and make settlement authority decisions.
• Negotiate and finalize claim settlements including lien resolution (Medicare, Medi-Cal, provider, attorney liens) in alignment with client authority.
• Aggressively pursue subrogation from culpable third parties, multi-defendant contributions, and apportionment on pre-existing disability cases.
• Respond to inquiries within required timeframes; maintain proactive communication with injured workers, employers, carriers, counsel, and vendors throughout the life of each claim.

Skills

WC claims adjusting

Fraud indicators identification

Medical management coordination

Education

Bachelor's degree required

SIP designation

Tools

Claims management platforms

Microsoft Office

Job description

AvonRisk, the nation’s leading specialty risk manager for self-insured organizations, seeks a Workers’ Compensation Claims Adjuster II in California. You will independently manage a complex indemnity claims portfolio from intake to resolution, applying sound judgment and knowledge of WC statutes while coordinating medical management and recovery strategies.

This hybrid role requires three days per week at a local AvonRisk office and proximity to an AvonRisk location.