Worker's Compensation Claims Adjuster
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About the job
Address: USA-MA-Quincy-1385 Hancock Street
Store Code: Claims Management (2762248)
Retail Business Services is the services company of leading grocery retail group Ahold Delhaize USA, providing services to five East Coast grocery brands: Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Retail Business Services leverages the size and scale of the local brands to and provides industry-leading expertise, insights and analytics to local brands to support their strategies. We are committed to diversity, equity and inclusion and we foster a community of belonging where everyone is valued. For more information, visit https://www.retailbusinessservices.com.
This role is responsible for the timely, good faith adjustment and disposition of self-administered casualty claims in multiple jurisdictions. Responsibility extends to all aspects and phases of investigations to determine compensability or liability, evaluations, negotiations and settlements/denials of Workers’ Compensation claims. This role has direct responsibility for managing the claim in its entirety while maintaining service and quality level targets.
This role is responsible, specialized technical work investigating and processing claims for self-insured claims programs. This role is the primary claim interface to associates, attorneys, healthcare providers, vendor partners and Brand partners.
Principle Duties and Responsibilities:
- Manage assigned Workers Compensation caseload within established targets and financial authority. Performance standards include 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 Brand bottom lines.
- Identify fraud indicators and actively pursue subrogation opportunities.
- Monitor and actively manage medical treatment with the goal of minimizing disability and fostering a successful re-entry to the workplace.
- Solid understanding of state and federal laws associated with employee relations, including, but not limited to: FMLA, and ADA,
- Closely monitor and manage prescriptions. Work with PBM to authorize prescriptions related to the injury.
- 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 effective 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 Workers’ Compensation claims business up to $5 million with authority to settle/negotiate a single claim within their authority of up to $75,000 (Corporate Authority policy)
- Communicate ongoing causes of associate or customer injuries to Safety and Brands.
- Serve as the primary point of contact to address and resolve claim issues impacting 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.
- Licensed adjuster in NC, GA, and/or SC.
- Bachelor’s degree or 4-5 years WC claims experience
- Thorough knowledge of rules, regulations, statutes and procedures pertaining to workers' compensation and general liability claims.
- Knowledge of medical terminology involved in complex claims
- Strong negotiation skills.
Skills and Abilities:
- 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
- Integrity – ability to maintain confidential information.
- Able to apply critical thinking when solving problems and making decisions.
Retail Business Services is an equal opportunity employer. We comply with all applicable federal, state and local laws. Qualified applicants are considered without regard to sex, race, color, ancestry, national origin, citizenship status, religion, age, marital status (including civil unions), military service, veteran status, pregnancy (including childbirth and related medical conditions), genetic information, sexual orientation, gender identity, legally recognized disability, domestic violence victim status or any other characteristic protected by law. We provide reasonable accommodations to applicants and employees with disabilities.
If you have a disability and require assistance in the application process, please contact our Talent Acquisition Department at firstname.lastname@example.org>
Job Requisition: 240885_external_USA-MA-Quincy_412022
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