Case Manager II, Claims Management

Position Summary... What you'll do... About the Team Our Claims Management team is dedicated to delivering fair, timely, and empathetic resolution of workers compensation and general liability claims, ensuring compliance with all regulatory requirements. We operate collaboratively, leveraging expertise and strategic initiatives to drive claim resolution and support injured associates and customers throughout the process. The Case Manager II is responsible for investigating, evaluating, and resolving mid complexity workers compensation or general liability claims. What youll do Claims Management Secure and maintain the required licensure required by the state(s). Manage an active caseload of up to 140 mid complexity 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. Establish timely and accurate reserves; Escalate claims to the Claims Manager if claim value exceeds reserve authority. Adjudicate claims within reserve authority up to $150,000 and payment authority $35,000. Authorize, monitor, and approve 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. Prepare for and present claims during roundtable and serious case reviews to discuss claim or resolution strategies and/or secure settlement authority. Issue settlement payments within authority limit; Escalate claims to the Claims Manager if payment exceeds authority. Escalate claims complex claims or claims with litigation potential to leadership. Participate in roundtable reviews and complete serious case reviews. 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. What you'll bring... High School Diploma or GED required Strong organizational skills and the ability to manage time effectively in a fast-paced environment. Excellent verbal and written communication skills The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a comprehensive inventory of all responsibilities and qualifications required of employees assigned to this job. The full Job Description can be made available as part of the hiring process. Benefits & Perks: At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more. You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable. About Walmart At Walmart, we help people save money so they can live better. This mission serves as the foundation for every decision we make, from responsible sourcing to sustainabilityand everything in between. As a Walmart associate, you will play an integral role in shaping the future of retail, tech, merchandising, finance and hundreds of other industriesall while affecting the lives of millions of customers all over the world. Here, your work makes an impact every day. What are you waiting for? At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more. You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable. For information about PTO, see https://one.walmart.com/notices. Live Better U is a Walmart-paid education benefit program 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. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms. For information about benefits and eligibility, see One.Walmart. The annual salary range for this position is $70,000.00-$130,000.00 Additional compensation includes annual or quarterly performance bonuses. Additional compensation for certain positions may also include: - Stock Minimum Qualifications... Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications. Bachelor's degree OR 2 years experience in insurance claims or related area. Insurance Adjuster license OR will obtain an Insurance Adjuster license within 30 days of job entry date Preferred Qualifications... Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications. Settling claims and customer service Primary Location... 905 Customer Dr, Bentonville, AR 72716, United States of America Walmart and its subsidiaries are committed to maintaining a drug-free workplace and has a no tolerance policy regarding the use of illegal drugs and alcohol on the job. This policy applies to all employees and aims to create a safe and productive work environment. About Walmart: Fifty years ago, Sam Walton started a single mom-and-pop shop and transformed it into the world's biggest retailer. Since those founding days, one thing has remained consistent: our commitment to helping our customers save money so they can live better. Today, we're reinventing the shopping experience and our associates are at the heart of it. You'll play a crucial role in shaping the future of retail, improving millions of lives around the world. This is that place where your passions meet purpose. Join our family and create a career you're proud of.