Case Manager II, Claims Management

Claims Management•Bentonville, AR

7d•Onsite

About The Position

The Case Manager II, Claims Management, is responsible for managing mid-complexity workers’ compensation and general liability claims throughout the claim lifecycle. This role involves reviewing claim reports, determining compensability, authorizing medical treatment, and negotiating resolutions while ensuring compliance with regulatory standards. The position requires establishing accurate reserves, escalating cases as needed, and collaborating with stakeholders to achieve timely outcomes. The Case Manager II supports continuous improvement initiatives and delivers exceptional service by applying expertise in claims investigations, resolution, and case management within established authority limits. The Walmart Claims Services team manages workers’ compensation and general liability claims with precision and professionalism. They review reports, verify documentation, and ensure timely resolution while adhering to regulations. Collaborating with internal partners and external providers, the team supports claimants throughout the process. Focused on integrity and efficiency, they handle complex caseloads, escalate issues appropriately, and uphold company values. Committed to consistent service quality, the team fosters strong relationships and continuously improves processes to support Walmart’s mission and operational excellence.

Requirements

Proven experience in claims investigations, resolution, and case management within workers’ compensation or general liability contexts.
Ability to manage mid-complexity claims throughout the lifecycle, including reserving, adjudication, and escalation as needed.
Knowledge of regulatory and jurisdictional requirements, ensuring compliance in all claim decisions and processes.
Strong communication skills to effectively engage with injured associates, customers, and legal representatives.
Capability to authorize and monitor medical treatments aligned with Official Disability Guidelines.
Demonstrated commitment to ethical standards, integrity, and delivering exceptional customer service.
Proficiency in analyzing data and applying best practices to improve claim outcomes and operational efficiency.
Option 1: High school diploma, GED, or equivalent and 1 year’s experience in claims management, insurance operations, or related area.
Option 2: 3 years’ experience in claims management, insurance operations, or related area.
Current or prior (within last 3 years) Property & Casualty Adjuster License.

Nice To Haves

Settling claims and customer service

Responsibilities

Review and analyze initial claim reports to determine compensability in accordance with jurisdictional statutes.
Manage a caseload of mid-complexity workers’ compensation and general liability claims throughout the claim lifecycle.
Establish and adjust reserves within authority limits, escalating cases exceeding thresholds.
Authorize and monitor medical treatments to ensure necessity and compliance with guidelines.
Calculate wages and issue indemnity payments per jurisdictional requirements.
Communicate effectively with claimants and stakeholders to facilitate claim resolution.
Negotiate settlements and present claims in review forums to secure approvals.
Identify potential fraud indicators and escalate appropriately.
Ensure compliance with regulatory and internal policies while meeting performance goals.

Benefits

Medical coverage
Vision coverage
Dental coverage
401(k)
Stock purchase
Company-paid life insurance
PTO (including sick leave)
Parental leave
Family care leave
Bereavement
Jury duty
Voting leave
Short-term disability
Long-term disability
Company discounts
Military Leave Pay
Adoption and surrogacy expense reimbursement
PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes.
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.