Worker's Compensation Claims Adjuster I

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 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 I at AvonRisk, you’ll manage a caseload of medical only WC claims under close supervision. Your focus is on timely investigation, appropriate medical bill review, utilization management, and driving claims to resolution, without the indemnity complexity. You’ll have experienced mentors, clear guidance, and real responsibility from day one, with exposure to a diverse range of claim types and industries.

Medical only claims represent an ideal entry point for developing strong WC fundamentals. If you’re looking to build a career in claims with a team that invests in its people, this role is for you.

Location & Work Arrangement:

Candidates should be based in Texas but are able to work fully remote.

Essential Duties & Responsibilities:

Claims Investigation & Compensability:

• •Conduct three-point contact with the injured worker, employer, and treating physician within required timeframes to initiate the claim and gather essential facts.
• •Assess compensability, evaluate mechanism of injury, and make benefit determinations in accordance with applicable state WC statutes; escalate questionable AOE/COE claims for SIU referral when appropriate.
• •Maintain accurate claim documentation and ensure claims are properly classified as medical-only throughout their life cycle.

Medical Management:

• •Direct medical care throughout the life of the claim, including maintaining medical control where applicable and objecting to unnecessary or unreasonable treatment.
• •Coordinate with AvonRisk’s dedicated utilization review and medical bill review teams, providing claim context and following through on their determinations.
• •Monitor injured workers’ progress toward maximum medical improvement (MMI) and coordinate with treating physicians to facilitate timely return-to-work outcomes.
• •Identify claims at risk of escalating to indemnity status and flag for timely supervisory review.

Reserving & Reporting:

Establish initial reserves based on investigation findings; monitor and adjust at periodic intervals and submit 90-day carrier status reports in compliance with client and regulatory requirements.

Settlements & Recovery:

Negotiate and finalize claim settlements including lien resolution in alignment with client authority; identify and manage subrogation opportunities, coordinating with recovery specialists as needed.

Requirements

Qualifications:

Education & Experience:

1–3 years of experience as a WC Claims Assistant, Trainee, or Future Med Adjuster; OR· Bachelor’s degree and a minimum of six months of WC claims experience.

Licenses & Certifications:

• •Active Texas Worker's Comp or all lines license required; multi-state preferred.
• •Designation such as AIC, ARM, SIP, or WCCP a plus but not required.

Technical Skills:

• •Familiarity with claims management platforms (e.g., Guidewire, Juris, ClaimCenter) preferred.
• •Working knowledge of Texas WC statutes; proficiency in Microsoft Office Suite; ability to read and interpret medical records.

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

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 Opportunity Employer:

AvonRisk is 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.

#LI-Remote #LI-ET1