Workers Compensation Claims Adjuster III

AvonRisk; Rocklin (CA); On-site; USD 90,000 - 100,000; Full time

Benefits offered by this job

Medical, Dental, Vision

HSA/FSA contributions

Life and Disability Insurance

401(k) with match

PTO & Holidays

Learning & Development

Employee assistance program

Job summary

AvonRisk is seeking a claims professional to manage an assigned inventory of claim files through resolution, reporting to the unit Claims Supervisor. The role involves handling complex or high-potential subrogation and legal issues in compliance with applicable statutes.

You will document case facts, develop action plans, coordinate with medical case managers to maximize early return to work, and ensure accurate billing and reserves while maintaining professional client service.

Qualifications

• Bachelor's degree plus seven years related experience and SIP certificate.
• Experience managing indemnity claims, subrogation, rehabilitation, medical management, and legal issues.
• Knowledge of California workers' compensation statutes and rules.

Responsibilities

• Manage an assigned inventory of claim files to resolution with timely updates.
• Document case facts and actions for compensability, disability payments, and vendor usage.
• Develop and approve plans of action for indemnity claims and subrogation efforts.
• Collaborate with medical case managers to maximize early return to work.
• Refer suspected fraud to SIU and oversee litigation processes.

Skills

Problem Solving

Customer Service

Interpersonal

Team Work

Education

Bachelor's degree in related field

SIP certification

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, 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

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

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; at least seven 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

$90,000 - $100,000

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

• 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.