Workers Compensation Claims Adjuster Analyst I

About the role

Primary responsibilities include investigation of Workers Compensation claims to determine compensability of the claim. This role has direct responsibility of managing the claim in its entirety while maintaining service level targets and achieving established claims goals. This role is the primary interface to associates, attorneys, healthcare providers, vendor partners and Brand partners.

Responsibilities

Claims Management

• Manage WC caseload within established targets and appropriate level.
• Perform thorough investigations, evaluations, negotiation and disposition of all claims, while ensuring that all claims are in compliance with statutory and legal obligations.
• Monitor and ensure timely execution of all statutory deadlines or legal filings as needed.
• Analyze fact of the loss to understand the nature of the claim to develop strategies that provide optimal outcome and mitigate the overall Total Cost of Risk to the Banners' bottom lines.
• Identify fraud indicators and actively pursue subrogation opportunities.
• Collaborate with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks.
• Build and maintain positive relationships with internal (Brands, Distributions Centers, Transportation, Ecommerce, Human Resources, Legal, Insurance) and external (vendors, healthcare providers, outside attorneys) customers.

Financial Impact Administration

• Manage book of claims business (up to $1 million WC) with authority to settle/negotiate a single claim within their authority of up to $50,000 (Corporate Authority policy).
• Communicate ongoing causes of WC injuries to Safety and Brands.
• Serve as the primary point of contact to address and resolve claim issues impacting customer, associate, vendor, and the Brands.
• Research and resolve claim/legal issues.
• Provide timely communication related to the claim, resolving issues, and responding to questions via phone, email, and online applications.

Requirements

• Licensed adjuster or ability to obtain license (as appropriate by jurisdiction).
• Bachelor's degree or 4 years WC claims experience.
• Thorough knowledge of rules, regulations, statutes and procedures pertaining to workers' compensation claims.
• Knowledge of medical terminology involved in complex claims.
• Strong negotiation skills.

Skills

• Demonstrates relationship building and communication skills, both written and verbal.
• Highly self-motivated, goal oriented, and works well under pressure.
• Customer focused solid understanding of WC legal procedures, processes, practices and standards in the handling of complex claims.
• Ability to identify problems and effectuate solutions.
• Ability to manage multiple tasks simultaneously with excellent follow-up and attention to detail.
• Able to apply critical thinking when solving problems and making decisions.

Schedule

Our flexible/hybrid work schedule includes 1 in-person day at one of our core locations and 4 remote days.

Pay

ME/NC/PA/SC Salary Range: $26.54 - $39.81

IL/MA/MD/NY Salary Range: $30.54 - $45.81

Actual compensation offered to a candidate may vary based on their unique qualifications and experience, internal equity, and market conditions. Final compensation decisions will be made in accordance with company policies and applicable laws.