Workers Compensation Claims Adjuster III (LAPD)

AvonRisk; Orange (CA); On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Comprehensive benefits

401(k) with company match

Paid time off

Job summary

AvonRisk is seeking a Claims Specialist to manage an inventory of complex claim files. You will document facts, establish compensability, and collaborate with medical case managers to optimize outcomes while adhering to statutes and company guidelines.

The role requires strong problem-solving, customer service, and teamwork skills, with a background in California workers' compensation claims and SIP certification. Competitive salary and benefits offered.

Qualifications

• Bachelor's degree from four-year college or university is required.
• Minimum of seven years related experience and/or training; or equivalent.
• Requires SIP certificate and proven claims handling expertise.

Responsibilities

• Perform three-point contact on all new losses within 24 hours to document facts.
• Document ongoing case facts for compensability, disability payments, and vendor use.
• Maintain up-to-date plan of action for indemnity claims and move cases toward closure.
• Partner with medical case manager to maximize early return-to-work potential and reduce costs.
• Initiate referral to SIU for suspected fraud and pursue subrogation.
• Ensure claims handling complies with statutes, contracts, and guidelines.

Skills

Problem Solving

Customer Service

Interpersonal

Team Work

Education

Bachelor's degree

7+ years experience

SIP certificate

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 their careers 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

Summary

Reports directly to the unit Claims Supervisor and may be called upon to provide technical backup in the absence of the Claims Supervisor. In accordance with applicable statutes and in keeping with company rules, regulations, and established performance objectives, the employee is responsible for effectively managing to conclusion an assigned inventory of claim files that may include cases of extreme complexity or with unique or unusual issues.

Essential Duties and Responsibilities

• Perform a three‑point contact on all new losses within 24 hours of receipt of the claim to include the claimant, employer, and treating physician to document relevant facts surrounding the incident itself as well as disability and treatment status.
• Thoroughly and accurately document ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and what is being done to move the case toward closure.
• Assure that all assigned indemnity claims have an up to date plan of action outlining activities and actions anticipated for ultimately resolving the claim.
• Form a partnership with the medical case manager to maximize early return to work potential thereby reducing the need for extended disability payments, vocational rehabilitation, and other protracted claims costs.
• Initiate the referral to the SIU of cases with suspected fraud.
• Aggressively pursue subrogation from culpable third parties, contributions on multiple defendant cases, and apportionment when there is pre‑existing disability.
• Assure that the claim file is handled totally in accordance with applicable statutes as well as in‑force service contracts and company guidelines.
• Review and approve all vocational rehabilitation plans.
• Establish, monitor, and adjust monetary case reserves when warranted and in strict accordance with assigned authority levels.
• Review all medical bills for appropriateness prior to referral to InterMed for payment and posting to the claim file.
• Exhibit and maintain a courteous and helpful attitude and project a professional image on behalf of the company.
• Respond to telephone messages and inquiries within 24 hours of receipt and to written inquiries within one week of receipt.
• Requires a working knowledge of the Labor Code of the State of California as it pertains to workers compensation claims and the legal requirements for handling them.
• Litigation management - Direct, manage, and control the litigation process.
• Handles other duties and tasks as deemed appropriate by the Supervisor or Manager.

Requirements

Competency

• Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully; develops alternative solutions; uses reason even when dealing with emotional topics.
• Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; responds to requests for service and assistance; meets commitments.
• Interpersonal - Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control; remains open to others’ ideas and tries new things.
• Team Work - Supports everyone's efforts to succeed.

Qualification 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.

Education and/or Experience

• Bachelor's degree (B. A.) from four‑year college or university;
• Minimum of seven (7) years related experience and/or training; OR
• Equivalent combination of education and experience.
• Requires a high degree of claims handling expertise to include a minimum of at least five years experience managing indemnity cases, many with complex or high potential subrogation, rehabilitation, medical management, and/or legal issues & possess an SIP certificate.

Salary Range

$80k - $100k

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
• Learning and development opportunities that support real career advancement
• Employee assistance resources and a supportive culture that values balance and wellbeing

We’re 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.