Workers Compensation Claims Adjuster II

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.

Role Summary:

As a Workers’ Compensation Claims Adjuster II at AvonRisk, you’ll independently manage a complex inventory of indemnity claims from intake through resolution, applying sound judgment, strong knowledge of applicable WC statutes, and a proactive approach to medical management, litigation, and recovery. You’ll report to your unit Claims Supervisor and work across a diverse portfolio of self-insured client accounts.

Location & Work Arrangement:

This is a hybrid position requiring three (3) days per week at your designated AvonRisk office.   Candidates must be located within commuting distance of an AvonRisk office location. Position can be based in Orange, CA or Glendale, CA.

Essential Duties & Responsibilities:

Claims Investigation & Compensability:

• Perform three-point contact within 24 hours on all new losses; thoroughly gather and analyze case facts, assess compensability, and maintain current plans of action on all assigned indemnity files.
• Identify and refer fraud indicators to the SIU; assure all claims are handled in accordance with applicable statutes, service contracts, and company guidelines.

Medical Management:

• Direct medical care throughout the claim lifecycle including treatment authorization, maintaining medical control, UR and IME direction, and VR plan review; partner with case managers to maximize early return-to-work.
• Identify and rate permanent disability (PD) in accordance with applicable state guidelines; incorporate PD findings into reserve and settlement strategy.

Reserving & Reporting:

• Establish, monitor, and adjust case reserves within assigned authority levels as facts develop; prepare 90-day carrier status reports with accuracy and strategic clarity.

Litigation Management:

• Direct defense counsel, set litigation strategy, manage legal budgets, and drive litigated files toward efficient resolution; attend mediations and settlement conferences and make settlement authority decisions.

Settlements & Recovery:

• Negotiate and finalize claim settlements including lien resolution (Medicare, Medi-Cal, provider, attorney liens) in alignment with client authority.
• Aggressively pursue subrogation from culpable third parties, multi-defendant contributions, and apportionment on pre-existing disability cases.

Professionalism & Communication:

• Respond to inquiries within required timeframes; maintain proactive communication with injured workers, employers, carriers, counsel, and vendors throughout the life of each claim.