Case Manager II, Claims Management
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 Claims Management team handles mid-complexity product general liability claims with a focus on thorough investigation, evaluation, and resolution. Team members manage active caseloads, ensuring compliance with regulatory standards and company policies. They collaborate closely with stakeholders to deliver timely, accurate outcomes while maintaining high ethical standards. The team supports continuous improvement through strategic initiatives and effective communication. Expertise in claims investigations, resolution, and case management is essential to uphold service quality and operational excellence, contributing to a reliable and efficient claims process within the organization.
Requirements
- Proven experience managing mid-complexity workers’ compensation or general liability claims throughout the claim lifecycle.
- Strong skills in claims investigations, resolution, and case management aligned with jurisdictional statutes and regulatory requirements.
- Ability to establish accurate reserves and adjudicate claims within assigned financial authority.
- Proficiency in authorizing and monitoring medical treatment using Official Disability Guidelines and nurse resources.
- Effective communication and negotiation skills to resolve claims with associates, customers, or attorneys.
- Commitment to compliance with company policies, ethics, and regulatory standards.
- Capacity to support strategic initiatives and continuous improvement in claims outcomes.
- High school diploma, GED, or equivalent and 1 year’s experience in claims management, insurance operations, or related area.
- 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 and compliance with jurisdictional statutes.
- Manage a caseload of mid-complexity workers’ compensation and general liability claims throughout the claim lifecycle.
- Establish and monitor reserves within authority limits, escalating cases exceeding thresholds.
- Authorize and oversee medical treatment to ensure necessity and appropriateness.
- Calculate wages and issue indemnity payments in accordance with regulations.
- 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 as required.
- Maintain compliance with regulatory and internal policies while supporting continuous improvement initiatives.
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 expense reimbursement
- Surrogacy expense reimbursement
- PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes
- Walmart-paid education benefit program (Live Better U) for full-time and part-time associates
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
