Position Summary...What you'll do...Role summary: The (USA) 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, authorizing medical treatment, and negotiating resolutions while ensuring compliance with regulatory standards. The position requires establishing accurate reserves, escalating cases as needed, and collaborating with stakeholders to achieve timely outcomes. The Case Manager II supports continuous improvement initiatives and delivers exceptional service by applying expertise in claims investigations, resolution, and case management within established authority limits.
What you'll do: - Review and analyze initial claim reports to determine compensability in accordance 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 compliance with guidelines.
- Calculate wages and issue indemnity payments per jurisdictional requirements.
- Communicate effectively with claimants and stakeholders to facilitate claim resolution.
- Negotiate settlements and present claims in review forums to secure approvals.
- Identify potential fraud indicators and escalate appropriately.
- Ensure compliance with regulatory and internal policies while meeting performance goals.
What you'll bring: - Proven experience in claims investigations, resolution, and case management within workers' compensation or general liability contexts.
- Ability to manage mid-complexity claims throughout the lifecycle, including reserving, adjudication, and escalation as needed.
- Knowledge of regulatory and jurisdictional requirements, ensuring compliance in all claim decisions and processes.
- Strong communication skills to effectively engage with injured associates, customers, and legal representatives.
- Capability to authorize and monitor medical treatments aligned with Official Disability Guidelines.
- Demonstrated commitment to ethical standards, integrity, and delivering exceptional customer service.
- Proficiency in analyzing data and applying best practices to improve claim outcomes and operational efficiency.
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...608 Sw 8Th St., Bentonville, AR 72712-6207, United States of America
