Category/Area of Expertise: Risk Management & Insurance
Job Requisition: 535968
Address: USA-MA-Quincy-1385 Hancock Street
Store Code: Claims Management (5157503)
Role SummaryThe Analyst II role is an experienced adjusting position responsible for managing a caseload of incident-only, medical-only, and lost-time Workers' Compensation claims across multiple jurisdictions. This role functions as an independent claims handler, ensuring timely, compliant, and cost-effective claim resolution while supporting injured associates through recovery and return-to-work.
Analysts collaborate closely with internal partners and vendors and escalate complex issues to Specialists, Analyst III resources, or the Team Manager as appropriate. The role does not have direct people-management responsibility.
This position follows a hybrid schedule (1 day in-person at a core location, 4 remote days). This position can be based in one of our offices located in Salisbury, NC, Scarborough, ME, Quincy, MA and Carlisle, PA. Applicants must be currently authorized to work in the United States on a full-time basis.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
- Utilize 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 adjudicating experience, including lost-time claims.
- Requires extensive, hands-on experience investigating and adjudicating claims, including gathering statements and evidence, reviewing medical records, determining compensability, establishing reserves, and managing claims through resolution.\
