Workers Compensation Claims Adjuster III

AvonRisk; Clifton (TX); Remote; USD 70,000 - 110,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

Employer-paid life and disability

PTO and company holidays

Job summary

AvonRisk, a leading specialty risk manager, seeks a senior Workers’ Compensation Claims Adjuster III based in Texas with remote work options. You will handle the industry’s most complex, high-exposure indemnity cases, mentor junior staff, and coordinate with clients, carriers, and legal teams.

You’ll oversee litigation management from strategy to settlement, review medical management plans, and establish reserves with precise justification for large-scale claims.

Qualifications

• 7+ years of WC claims experience, including 5+ years in independent indemnity management.
• Experience with high-exposure, complex, litigated files.
• Bachelor’s degree and 5+ years of independent WC indemnity experience.
• Direct experience with one or more claims administration or processing platforms.

Responsibilities

• Lead complex investigations and compensability determinations for high-exposure claims.
• Direct medical management for catastrophic and high-complexity claims, coordinating UR, IMEs, and life care planning.
• Establish and adjust reserves with justification for high-exposure files.
• Direct the full litigation process for the unit’s complex files, select defense counsel, and manage legal spend.

Skills

WC claims experience

Indemnity management

Litigation management

Mentoring junior adjusters

Supervisory backup

Education

Bachelor's degree

Tools

Claims processing platforms

Job 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. 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.

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

Complex Claims Investigation & Compensability

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. review medical bills for appropriateness on high-cost and unusual treatment patterns.

Permanent Disability, Reserving & Financial Stewardship

establish and adjust reserves on high-exposure files with precision and clear documented justification.

Litigation Management

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. make or recommend high-value settlement authority decisions in coordination with the Claims Supervisor and client. manage multi-lien resolution (MSA, Medi-Cal, provider, attorney liens) 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. Serve as a senior point of contact for key client accounts on complex or escalated matters; respond within required timeframes and project a professional, expert image in all interactions.

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

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; Bachelor’s degree and a minimum of 5 years of WC indemnity experience at an independent level; Comprehensive knowledge of public entity liability claims including JPAs, self-insured programs, and pooled insurance arrangements.

Direct experience working within one or more claims administration or claims processing platforms commonly used in worker’s compensation/insurance claims handling.

Demonstrated experience directing complex litigation through mediation, settlement conference, and trial preparation; Experience with catastrophic injury management and life care planning coordination; familiarity with claims management platforms; proficiency in Microsoft Office.

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

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

Comprehensive medical, dental, and vision benefits

• ~ Employer-paid life and disability insurance
• ~Paid time off (PTO) and company-paid holidays

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