Worker's Claims Adjuster II

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Worker's Compensation Claims Adjuster II

Worker's Compensation Claims Adjuster II
Fully Remote TX

Full-time

Avon Risk 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, Inter Med, 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 Avon Risk, you’re part of a team that values good judgment, curiosity, and accountability, and gives you the support to succeed.

As a Workers’ Compensation Claims Adjuster II at Avon Risk, 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.

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

• 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.

• 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.

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

• 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.

• 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.

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

• Minimum of 3 years of Texas Worker's Compensation claims adjusting experience with a Bachelor's degree, with demonstrated ability to independently manage indemnity claims through resolution.
• 5 years of Texas Worker's Compensation claims adjusting experience without a Bachelor's degree, with demonstrated ability to independently manage indemnity claims through resolution.

• Active Texas Worker's Comp or all lines license required; multi-state preferred.
• Professional designations such…