Workers Comp Claims Specialist

PetSmart-posted 1 day ago

Full-time • Mid Level

Hybrid • Phoenix, AZ

5,001-10,000 employees

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The Workers’ Compensation Claims Specialist supports the Risk Management department by developing, executing, and overseeing workers’ compensation claims programs designed to identify loss trends, reduce claim frequency and severity, and drive positive claim outcomes. This role provides oversight of the Third-Party Administrator (TPA) and partners cross-functionally to ensure effective claims resolution, cost containment, and compliance with applicable regulations. The position requires strong technical knowledge of workers’ compensation principles, regulations, and procedures, along with excellent interpersonal skills, sound judgment, time management, and discretion.

Assist in directing the workers’ compensation claims management program, including TPAs and vendors, to ensure timely, quality claimant care and appropriate financial reserve practices.
Monitor TPA and ancillary service provider performance to ensure contractual compliance and achievement of established service level agreements (SLAs), metrics, and performance expectations.
Oversee the TPA Associate Claim Advocate to support an advocacy-based workers’ compensation program, including regular touch-base meetings, strategy discussions, and input into performance evaluations.
Identify, evaluate, and assess the probability and severity of losses on claims at risk of adverse development.
Analyze claim trends and provide findings and recommendations to Risk Leadership.
Utilize TPA claims systems and RMIS platforms to develop dashboards, review and validate claim data, and maintain accurate claim reporting.
Manage the full Transitional Duty program and provide strategic recommendations for the Return-to-Work program.
Support Stores and Distribution Centers with workers’ compensation-related questions and activities.
Collaborate with field leadership to ensure consistent application of Transitional Duty guidelines and monitor associate progress and compliance.
Authorize claim settlements and reserve increases within assigned authority levels.
Support the development, implementation, and monitoring of cost-containment strategies to prevent and minimize losses.
Travel required for approximately five business trips annually for claim reviews and conferences.
Partner with Risk Management, Human Resources, and Safety/Loss Prevention teams to ensure alignment on workers’ compensation activities.
Collaborate with the Senior Claims Manager and TPA to provide internal training and guidance on best practices, state law compliance, and program updates.
Confirm and communicate approved medical provider networks and provide associate training as needed.

Excellent written and verbal communication skills.
High level of discretion and ability to maintain confidentiality.
Thorough working knowledge of workers’ compensation claims management and procedures.
General understanding of workers’ compensation laws and regulations.
Strong analytical skills with the ability to compile, organize, and present data.
Ability to work effectively in a team-oriented, cross-functional environment.
Proven ability to manage multiple priorities and coordinate information efficiently.
Proficiency with software applications and the ability to troubleshoot system issues.
Proficient in Microsoft Office applications.
Ability to quickly learn and effectively use TPA claims systems and RMIS platforms.
Bachelor’s degree preferred, or Associate’s degree with insurance-related coursework.
Minimum of three (3) years of experience working with a Third-Party workers’ compensation Claims Administrator.
An equivalent combination of education and experience may be considered.

Experience with other claims lines (e.g., property, cargo, general liability) is a plus but not required.
Claims Adjuster designation preferred.

Pet-friendly environment, bring your pets to work and enjoy the on-site dog park!
On-Site Events & Adoptions, enjoy community-building opportunities, including pet adoption days, seasonal celebrations, family events, art events, & holiday festivals
“Top Dog” gym with equipment, fitness classes, massage therapists, personal trainers, and wellness spaces
“Sit & Stay” Café serving fresh breakfast and lunch options, snacks, & more
“Lil Paws” NAEYC-accredited onsite childcare facility providing high-quality early education
Paid Volunteer Opportunities to spend time doing good for causes close to heart
Print Center and Business Services, Dry Cleaning, Mother's Rooms, Sustainable Infrastructure & more

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