Case Manager II, Claims Management

Claims Management

Our Claims Management team is dedicated to delivering fair, timely, and empathetic resolution of workers' compensation and general liability claims, ensuring compliance with all regulatory requirements. We operate collaboratively, leveraging expertise and strategic initiatives to drive claim resolution and support injured associates and customers throughout the process.

Case Manager II

The Case Manager II is responsible for investigating, evaluating, and resolving mid complexity workers' compensation or general liability claims.

Claims Management

• Secure and maintain the required licensure required by the state(s).
• Manage an active caseload of up to 140 mid complexity workers' compensation or general liability claims.
• Secure and review initial claim reports, gather information, facts, and evidence to determine compensability or negligence in accordance with state specific statutes.
• Identify and escalate potential fraudulent claims.
• Communicate with injured associates or customers that have sustained bodily injury with empathy and help them navigate the claims process.
• Establish timely and accurate reserves; escalate claims to the Claims Manager if claim value exceeds reserve authority.
• Adjudicate claims within reserve authority up to $150,000 and payment authority $35,000.
• Authorize, monitor, and approve payment for medical treatment that is reasonable, necessary, and related.
• Leverage the Official Disability Guidelines (ODG) and nurse resources to coordinate early return to work to prevent/mitigate lost time; if lost time occurs, calculate wages and issue indemnity payment(s) timely in accordance with the jurisdictional requirement.
• Negotiate and resolve claims with associates, customers or their attorney.
• Prepare for and present claims during roundtable and serious case reviews to discuss claim or resolution strategies and/or secure settlement authority.
• Issue settlement payments within authority limit; escalate claims to the Claims Manager if payment exceeds authority.
• Escalate claims complex claims or claims with litigation potential to leadership.
• Participate in roundtable reviews and complete serious case reviews.
• Meet or exceed goals on key performance metrics.
• Ensure compliance with all regulatory, jurisdictional, and internal standard operating procedures.
• Deliver exceptional customer service to injured associates, customers, the employer, and clients.

Benefits & Perks:

At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more.

You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable.

Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms.

The annual salary range for this position is $70,000.00-$130,000.00. Additional compensation includes annual or quarterly performance bonuses. Additional compensation for certain positions may also include:

• Stock

Minimum Qualifications:

Bachelor's degree OR 2 years' experience in insurance claims or related area. Insurance Adjuster license OR will obtain an Insurance Adjuster license within 30 days of job entry date.

Preferred Qualifications:

Settling claims and customer service

Primary Location: 608 Sw 8Th St, Bentonville, AR 72712-6207, United States of America

Walmart and its subsidiaries are committed to maintaining a drug-free workplace and has a no tolerance policy regarding the use of illegal drugs and alcohol on the job. This policy applies to all employees and aims to create a safe and productive work environment. Walmart, Inc. is an Equal Opportunity Employer- By Choice. We believe we are best equipped to help our associates, customers, and the communities we serve live better when we really know them. That means understanding, respecting, and valuing diversity- unique styles, experiences, identities, abilities, ideas and opinions- while being inclusive of all people.