Workers Compensation Claims Adjuster III (LAPD)

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

Benefits offered by this job

Comprehensive medical, dental, and vision benefits

401(k) with company match

Paid time off (PTO)

Learning and development opportunities

Job summary

AvonRisk LLC in California is seeking a Claims Handler to effectively manage an assigned inventory of claims, ensuring timely resolution and compliance with regulations. The ideal candidate will have at least seven years of experience in claims handling, including complex indemnity cases.

The position includes responsibilities such as documenting claims details, working with medical case managers, and ensuring adherence to legal requirements. Competitive salary and comprehensive benefits are offered.

Qualifications

• Minimum of seven years of related experience and/or training required.
• Requires a high degree of claims handling expertise.
• Experience managing indemnity cases with complex issues is necessary.

Responsibilities

• Manage an assigned inventory of claim files, ensuring timely resolutions.
• Document relevant facts surrounding claims and treatment status.
• Establish action plans for claim resolution.

Skills

Problem Solving

Customer Service

Interpersonal Communication

Team Work

Education

Bachelor's degree

Job description

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, 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.

Competency

To perform the job successfully, an individual should demonstrate the following competencies:

• 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 & possessing an SIP certificate.

Salary Range

$80k-$100k

The salary range listed is an estimate. Actual compensation will be determined based on several factors such as a candidate’s experience, qualifications, skill set, and work location.

Benefits

We take care of our people so they can take care of their work and their teams! AvonRisk offers a competitive, people first benefits package designed to support your health, financial security, and career growth, including:

• 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

Equal Employment Opportunity

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.