Workers Compensation Claims Adjuster III

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 III at AvonRisk, you are a senior technical expert trusted with the organization’s most complex, high-exposure, and strategically sensitive claims—including catastrophic injuries, multi-party litigation, and cases with novel legal or medical challenges. You provide technical guidance and supervisory backup to your unit and serve as a senior resource for clients, carriers, and colleagues.

Location & Work Arrangement:

Position is approved for remote work, candidates must be based in Texas with preference for Austin area.

Essential Duties & Responsibilities:

Complex Claims Investigation & Compensability

• Perform three-point contact on all new losses and apply heightened scrutiny to complex, catastrophic, and high-exposure cases; maintain detailed plans of action with strategic resolution planning on all assigned indemnity files.
• Identify fraud indicators and refer to SIU with advanced pattern recognition; gather and document case facts on files involving multi-party liability, catastrophic injury, significant subrogation potential, or novel legal issues.

Medical Management, RTW & Vocational Rehabilitation

• Lead medical management on catastrophic and high-complexity claims including directing specialists, coordinating life care planners, directing UR and IMEs, and managing PTD cases.
• Partner with case managers to maximize early RTW; review medical bills for appropriateness on high-cost and unusual treatment patterns.

Permanent Disability, Reserving & Financial Stewardship

• Lead PD rating on complex cases including significant apportionment, overlapping injuries, and disputed ratings; establish and adjust reserves on high-exposure files with precision and clear documented justification.
• Ensure status reports are submitted in compliance with the reporting timelines and formats outlined in individual client instructions.

Litigation Management

• Independently direct the full litigation process on the unit’s most complex files including selecting defense counsel, setting strategy, retaining experts, managing legal spend, and preparing for trial.
• Lead mediations, settlement conferences, and arbitrations; make or recommend high-value settlement authority decisions in coordination with the Claims Supervisor and client.

Settlements, Lien Resolution & Recovery

• Independently negotiate and finalize high-value settlements including C&R and Stipulated Awards; manage multi-lien resolution (MSA, Medi-Cal, provider, attorney liens) and coordinate with lien counsel and CMS as required.
• Aggressively pursue subrogation, multi-defendant contribution, and apportionment recovery; coordinate with recovery vendors and outside subrogation counsel on high-value opportunities.

Technical Leadership & Supervisory Backup

• Serve as technical backup for the Claims Supervisor; provide guidance on complex decisions, reserve adequacy, and escalated client issues; mentor Adjuster I and II colleagues and support unit-wide quality review.
• Serve as a senior point of contact for key client accounts on complex or escalated matters; maintain client and carrier relationships with professionalism and technical authority.

Professionalism & Communication

• Maintain proactive, transparent communication with all stakeholders; respond within required timeframes and project a professional, expert image in all interactions.