Worker's Compensation Claims Adjuster III

AvonRisk; Austin (TX); Remote; USD 95,000 - 140,000; Full time

Benefits offered by this job

Comprehensive medical, dental, and vis

HSA and FSA plans

Employer-paid life and disability

401(k) with company match

PTO and holidays

Employee assistance resources

Job summary

AvonRisk in Texas seeks a senior Workers' Compensation Claims Adjuster III to lead the most complex, high-exposure claims, including catastrophic injuries and multi-party litigation. You will provide technical guidance and act as a senior resource for clients, carriers, and colleagues.

Remote-friendly role based in Texas (Austin area preferred). You will mentor junior staff, direct litigation strategies, manage reserve adequacy, and collaborate across teams to deliver precise, data-driven

Qualifications

• Minimum 7 years WC claims experience with at least 5 years of independent indemnity management.
• Texas WC license required; multi-state license preferred.
• Experience directing complex litigation through mediation, settlement conference, and trial.

Responsibilities

• Perform complex claims investigations with emphasis on high-exposure files and strategic resolution planning.
• Lead medical management on catastrophic/high-complexity claims, coordinating UR/IMEs and life care planning.
• Lead PD rating on complex cases, establish and adjust reserves with justification.
• Independently direct full litigation processes for the most complex files, selecting counsel and managing spend.
• Negotiate and finalize high-value settlements and manage multi-lien resolution
• Serve as technical backup to the Claims Supervisor and mentor junior adjusters.

Skills

WC claims experience

Independent indemnity management

Litigation management

Client relationship management

Education

Bachelor's degree or equivalent

Tools

Claims processing platforms

Job description

Description

AvonRisk is the nation's leading specialty risk manager for self-insured organizations, uniting respected regional leaders in workers' compensation, liability, managed care, and risk management across 32 states. With nearly 700 professionals and brands including Intercare, InterMed, George Hills, and AS&G Claims Administration, we're a people-focused, operations-driven organization that prioritizes reasonable caseloads, strong training, collaborative teams, and expert support. We invest in tools and workflows that reduce friction - not increase volume, and create real career paths for professionals who want to grow or move into leadership. At AvonRisk, you're part of a team that values good judgment, curiosity, and accountability, and gives you the support to succeed.

Job Type

Full-time

Role Summary

As a Workers' Compensation Claims Adjuster III at AvonRisk, you are a senior technical expert trusted with the organization's most complex, high-exposure, and strategically sensitive claims—including catastrophic injuries, multi-party litigation, and cases with novel legal or medical challenges. You provide technical guidance and supervisory backup to your unit and serve as a senior resource for clients, carriers, and colleagues.

Location & Work Arrangement

Position is approved for remote work, candidates must be based in Texas with preference for Austin area.

Essential Duties & Responsibilities

Complex Claims Investigation & Compensability

• 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.

Medical Management, RTW & Vocational Rehabilitation

• 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.

Permanent Disability, Reserving & Financial Stewardship

• 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.


• Ensure status reports are submitted in compliance with the reporting timelines and formats outlined in individual client instructions.

Litigation Management

• Independently direct the full litigation process on the units 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.

Settlements, Lien Resolution & Recovery

• 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.

Technical Leadership & Supervisory Backup

• 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.

Professionalism & Communication

• Maintain proactive, transparent communication with all stakeholders; respond within required timeframes and project a professional, expert image in all interactions.

Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Qualifications

Education & Experience

• 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; OR


• 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.

Licenses & Certifications

• Active Texas Worker's Comp or all lines license required; multi-state preferred.


• Professional designations such as AIC, ARM, WCCP, or CPCU a plus but not required.

Technical & Subject Matter Expertise

• Deep expertise in Texas WC statutes; Multi-jurisdiction experience highly valued.


• Direct experience working within one or more claims administration or claims processing platforms commonly used in workers' compensation/insurance claims handling.


• Demonstrated experience directing complex litigation through mediation, settlement conference, and trial preparation; advanced knowledge of PD rating, MSA requirements, and multi-party lien resolution.


• Experience with catastrophic injury management and life care planning coordination; familiarity with claims management platforms; proficiency in Microsoft Office.

Leadership & Interpersonal Skills

• Demonstrated ability to mentor junior adjusters and serve as a supervisory backup or senior technical resource.


• Strong client relationship management skills; experience handling escalated concerns at a senior level.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.

Benefits

• Comprehensive medical, dental, and vision benefits


• Company contributions to HSA and FSA plans


• Employer-paid life and disability insurance


• 401(k) with company match


• Paid time off (PTO) and company-paid holidays


• Employee assistance resources and a supportive culture that values balance and wellbeing

Equal Opportunity Employer

AvonRisk is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records.