Senior Analyst, Claims Litigation

Walmart•Bentonville, AR

16h•Onsite

About The Position

The Senior Analyst, Claim Litigation is responsible for investigating, evaluating, and resolving complex workers’ compensation or general liability claims. This role is heavily engaged in claims that are either at risk for litigation or are already litigated depending on the line of business. The Senior Claim Analyst leverages their extensive claim knowledge and expertise to teach, train, and mentor lower tenured case managers.

Requirements

Bachelor's degree in Business, Arts, Science, or related field and 1 year experience in insurance claims, law or related field OR 3 years of experience in insurance claims, law or related field.
Insurance adjuster license.
Strong organizational skills and the ability to manage time effectively in a fast-paced environment.
Excellent verbal and written communication skills
High school diploma, GED, or equivalent and 2 years’ experience in claims handling.
4 years’ experience in claims handling, including experience with complex or litigated workers’ compensation or general liability claims.
Current or prior (within last 3 years) Property & Casualty Adjuster License.

Nice To Haves

Insurance industry or claims experience
Paralegal diploma approved by American Bar Association OR National Association of Legal Assistants Certified Legal Assistant certificate
Working in a legal environment
Doctorate: Law
Masters: Business Administration

Responsibilities

Manage an active caseload of up to 100 complex 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.
Timely escalate claims that meet the criteria of the internal Escalation Requirement List to leadership and internal Tort partners and/or outside counsel.
Collaborate with leadership, in-house counsel and outside counsel early to establish an agreed upon value, align on approach, and develop a strategy to get the best claim outcome possible.
Report timely to insurers when a claim meets the reporting criteria.
Establish timely and accurate reserves; Escalate claims to the Claims Manager if claim value exceeds reserve authority.
Adjudicate claims within reserve authority up to $175,000 and payment authority $50,000
Authorize, monitor, and issue 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.
Effectively oversee and manage outside counsel to ensure the litigation is moving forward and that there is a plan of action in place to reach resolution in a timely manner.
Approve payment for reasonable and related medical treatment or damages.
Issue settlement payments within authority limit; Escalate claims to the Claims Manager if payment exceeds authority.
Prepare for and present claims during roundtable and serious case reviews to discuss claim or resolution strategies and/or secure settlement authority.
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.
Teach, train, and mentor lower tenured case managers
Share claims knowledge and expertise
Serve as a subject matter expert (SME) as needed for special projects or 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 and 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 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.