Hybrid Workers' Comp Claims Analyst II | Return-to-Work

Hunt; Pleasant Hill (CA); On-site; USD 63,000 - 109,000; Full time

Job summary

Ahold Delhaize USA, a division of a global food retailer, seeks an experienced Analyst II to manage a diverse caseload of incident-only, medical-only, and lost-time Workers’ Compensation claims across multiple jurisdictions. In this role, you will act as an independent claims handler, ensuring timely, compliant resolutions and supporting injured associates toward recovery and return-to-work.

The position features a hybrid schedule (1 day in-person at a core location, 4 remote days) with offices

Qualifications

• Minimum 5 years of Workers’ Compensation claims adjudicating experience, including lost-time claims.
• 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.
• Active adjuster license(s), as required by jurisdiction, or ability to obtain.
• Working knowledge of Workers’ Compensation statutes, claim handling practices, and medical terminology.

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 elevate concerns in accordance with established protocols.
• Communicate clearly and professionally with associates, medical providers, attorneys, and vendors while maintaining strict confidentiality.

Skills

Negotiation

Analytical

Problem-solving

Communication

Prioritization

Adaptability

Education

Bachelor's degree

Job description

Ahold Delhaize USA, a division of a global food retailer, seeks an experienced Analyst II to manage a diverse caseload of incident-only, medical-only, and lost-time Workers’ Compensation claims across multiple jurisdictions. In this role, you will act as an independent claims handler, ensuring timely, compliant resolutions and supporting injured associates toward recovery and return-to-work.

The position features a hybrid schedule (1 day in-person at a core location, 4 remote days) with offices