Case Manager II, Claims Management

Walmart•Bentonville, AR

6d•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, establishing reserves, and adjudicating claims within financial authority. The position requires coordinating medical treatment authorization, calculating indemnity payments, and negotiating resolutions to achieve timely outcomes. The Case Manager supports strategic initiatives to enhance claim resolution, ensures compliance with regulatory standards, and collaborates with stakeholders to deliver exceptional service while maintaining required licensure and upholding company policies and ethical standards. The WCS team manages delivery claims by conducting thorough investigations, timely adjudication, and effective resolution of low-complexity claims. Team members ensure accurate documentation and regulatory compliance while collaborating with internal and external partners to support claimants. They maintain financial reserves within authority limits and apply strong negotiation and risk management skills. Emphasizing clear communication and professional engagement, the team continuously improves processes to deliver consistent service quality. Their efforts contribute to efficient claims processing aligned with company standards and values, fostering reliable and accountable claims management.

Requirements

Proven experience managing mid-complexity workers’ compensation or general liability claims throughout the claim lifecycle.
Strong skills in claims investigation, resolution, and case management aligned with jurisdictional statutes.
Ability to establish accurate reserves and adjudicate claims within assigned financial authority.
Knowledge of medical treatment authorization processes using Official Disability Guidelines and nurse resources.
Active or recently held Property & Casualty Adjuster License.
Effective communication and negotiation skills with associates, customers, and legal representatives.
Commitment to compliance with regulatory and internal policies while delivering exceptional customer service.
High school diploma, GED, or equivalent and 1 year’s experience in claims management, insurance operations, or related area.
OR 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

Bachelor’s degree in Risk Management, Insurance, Business Administration, Legal Studies, or related field.
experience in settling claims and customer service.
Industry designations (e.g., AIC, WCCP).

Responsibilities

Review and analyze initial claim reports to determine compensability in accordance with jurisdictional statutes.
Manage a caseload of mid-complexity workers’ compensation or 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 with claimants to facilitate understanding of the claims process.
Negotiate and resolve claims to achieve timely and appropriate outcomes.
Prepare and present claims for review to secure settlement authority or refine strategies.
Maintain required licensure and ensure compliance with regulatory and internal procedures.

Benefits

Competitive pay
Performance-based bonus awards
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
Live Better U (Walmart-paid education benefit program for full-time and part-time associates)