Worker's Compensation Analyst II Claims Adjuster

Key Responsibilities

• Manage an assigned caseload of incident-only, medical-only, and lost-time Workers' Compensation claims in compliance with applicable state laws and company policies.
• Conduct timely investigations to determine compensability, evaluate exposure, and develop appropriate claim strategies.
• Negotiate and manage settlements within assigned authority. Authority levels vary based on experience and demonstrated competency and align with corporate guidelines.
• Actively manage medical treatment to minimize disability duration and promote safe, timely return-to-work.
• Partner closely with Store Management, Distribution, Transportation, and Human Resources to support participation in the Light Duty RTW Program.
• Cook with nurse triage services at injury intake and during early claim activity to ensure appropriate care direction and reduce unnecessary emergency room utilization.
• Coordinate with PBM partners to monitor prescriptions and ensure medications are injury-related and appropriate.
• Identify potential fraud indicators and escalate concerns in accordance with established protocols.
• Communicate clearly and professionally with associates, medical providers, attorneys, and vendors while maintaining strict confidentiality.

Financial & Operational Impact

• Manages an assigned book of WC claims aligned with departmental performance targets.
• Works closely with the Safety team to enhance injury prevention and improve claim outcomes by sharing injury trends, supporting root-cause analysis, and reinforcing early intervention strategies focused on reducing lost time and claim escalation.

Basic Qualifications

• Minimum 5 years of Workers' Compensation claims handling experience, including lost-time claims.
• Active adjuster license(s), as required by jurisdiction, or ability to obtain.
• Bachelor's degree or equivalent professional experience.
• Working knowledge of Workers' Compensation statutes, claim handling practices, and medical terminology.

Preferred Qualifications

• Experience handling Workers' Compensation claims in multiple jurisdictions.
• Familiarity with retail, distribution, or transportation operations.
• Working knowledge of FMLA, ADA, and return-to-work coordination.

Skills & Abilities

• Strong negotiation, analytical, and problem-solving skills.
• Effective communication skills with internal and external partners.
• Ability to manage competing priorities in a fast-paced, high-volume environment.
• Demonstrated adaptability and willingness to grow technical claim expertise.