Position Summary...What you'll do...Role summary:The Case Manager II, Claims Management, is responsible for managing mid-complexity workers' compensation and general liability claims throughout the claim lifecycle. This role involves reviewing claim reports, determining compensability, establishing reserves, and adjudicating claims within financial authority. The position requires coordinating medical treatment authorization, calculating indemnity payments, and negotiating resolutions to achieve timely outcomes. The Case Manager collaborates with stakeholders, escalates complex claims as needed, and ensures compliance with regulatory standards while delivering exceptional service and contributing to continuous process improvements.
What you'll do:- Review and analyze claim reports to determine compensability and compliance with jurisdictional statutes.
- Manage a caseload of mid-complexity workers' compensation and general liability claims throughout the claim lifecycle.
- Establish and adjust reserves within authority limits, escalating cases exceeding thresholds.
- Authorize and monitor medical treatments to ensure necessity and appropriateness.
- Calculate wages and issue indemnity payments in accordance with regulations.
- Communicate effectively with claimants and stakeholders to facilitate claim resolution.
- Negotiate settlements and present claims in review forums to secure approvals.
- Maintain required licensure and ensure regulatory compliance.
- Support continuous improvement initiatives and collaborate with key partners to enhance claim outcomes.
What you'll bring: - Proven experience in claims investigations, resolution, and case management within workers' compensation or general liability contexts.
- Ability to review and analyze claim reports, determining compensability in accordance with jurisdictional statutes.
- Strong skills in adjudicating claims and establishing reserves within financial authority limits.
- Knowledge of medical treatment authorization processes using Official Disability Guidelines and nurse resources.
- Effective communication and negotiation skills to resolve claims with associates, customers, or legal representatives.
- Current or recently held Property & Casualty Adjuster License and understanding of regulatory compliance.
- Capacity to manage mid-complexity claims caseloads while meeting performance goals and delivering quality service.
This is an
onsite job based in
Bentonville, AR. 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
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Minimum Qualifications...Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Option 1: High school diploma, GED, or equivalent and 1 year's experience in claims management, insurance operations, or related area.
Option 2: 3 years' experience in claims management, insurance operations, or related area.
Current or prior (within last 3 years) Property & Casualty Adjuster License.
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
