Case Manager I, Claims Management (Evergreen)

Walmart•Bentonville, AR

19d•Hybrid

About The Position

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 The Case Manager I is responsible for investigating, evaluating, and resolving low complexity workers’ compensation or general liability claims.

Requirements

High School Diploma or GED required
Strong organizational skills and the ability to manage time effectively in a fast-paced environment.
Excellent verbal and written communication skills

Nice To Haves

Prior claims, insurance, or customer service experience is preferred.

Responsibilities

Secure and maintain the required licensure required by the state(s).
Manage an active caseload of up to 140 low 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.
Identify and escalate claims with Early Claims Assessment (ECA) potential.
Communicate with injured associates or customers that have sustained minor bodily injury or property damage with empathy and help them navigate the claims process.
Establish timely and accurate reserves on claims; Escalate claims to the Claims Manager if claim value exceeds reserve authority.
Adjudicate claims within reserve authority up to $35,000 ; Payment authority $2,500
Authorize and approve payment for reasonable and related medical treatment or damages.
Negotiate and resolve claims with associates and customers.
Issue settlement payments within authority limit; Escalate claims to the Claims Manager if payment exceeds authority.
Escalate claims with increasing complexity or litigation potential to the Claims Manager.
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.
Pass the adjuster licensing exam and obtain the state-issued adjuster license within required deadlines.