AvonRisk ยท 3 weeks ago
Worker's Compensation Claims Adjuster II
Orange, CA
Full-time
Onsite
Mid Level
$40.86/hr - $43.02/hr
3+ years expAvonRisk is seeking a Worker's Compensation Claims Adjuster II to manage an assigned inventory of claim files in accordance with applicable statutes and company guidelines. The role involves performing thorough investigations, managing litigation processes, and ensuring compliance with legal requirements related to workers compensation claims.
CommercialRisk ManagementService Industry
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 gather evidence regarding ongoing case facts and relevant information necessary for establishing compensability, the need for disability payments, the use of vendors, medical and expense payments, and the reason the claim is still open
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
Qualification
Required
Bachelor's degree (B. A.) or equivalent from four-year college or; or 3-5 years related experience & training, 5 years without a SIP certificate, or equivalent combination of education and experience
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
Company
AvonRisk
AvonRisk is a provider of risk management, claims administration, and managed care services for carriers, employers, and public entities.
501-1000 employees
Funding
Current Stage
Late StageCompany data provided by crunchbase