Risk Solutions Rep - Claims Adjuster (Houston Region)

H.E.B.; Houston (TX); On-site; USD 70,000 - 95,000; Full time

Job summary

H.E.B. seeks a Risk Solutions Representative to manage Risk Solutions Programs including Work Injury Benefit, Return-to-Work, Premises and Products Liability, and Loss Prevention Litigation.

The role involves investigating claims, litigation management, and coordinating safety initiatives across stores in accordance with OSHA regulations. Responsibilities include reviewing regulations, managing incident reports, coordinating with defense teams, and communicating with partners and customers.

Qualifications

• Bachelor’s Degree or equivalent training/experience.
• 2+ years related experience in risk/claims handling.
• Current All-Lines Claims Adjuster license through the Texas Department of Insurance.
• Bilingual English and Spanish preferred.

Responsibilities

• Investigates claims and RTW cases; recommends best action.
• Reviews OSHA and related regulations; informs staff.
• Manages litigation case management and communication with attorneys.
• Coordinates incident reviews and action plans.
• Communicates with partners and customers for service.
• Produces incident trends reports for leadership.
• Supports safety initiatives and risk programs.

Skills

Regulatory interface

Customer service

Telephone skills

Bilingual (English/Spanish)

Microsoft Office

Claims Management System

Project management

Education

Bachelor’s Degree or equivalent

Tools

Claims Management System

PPO utilization knowledge

Job description

Responsibilities

Job Summary: As a Risk Solutions Representative, you'll manage and administer Risk Solutions Programs with the guidance of Risk Leadership: Work Injury Benefit Plan, Return-to-Work Benefit Plan, Premises and Products Liability Program, and Loss Prevention Litigation. You'll handle claims and conduct litigation management. Facilitate safety initiatives with assigned stores / locations within OSHA regulations.

Key Responsibilities & Essential Functions

• Conducts investigations on all types of claims and RTW cases and provides recommendation for best course of action
• Reviews and interprets existing, new or proposed OSHA and other federal and state regulations, updates to department staff as necessary
• Investigates and documents hazard reviews; analyzes, evaluates and presents recommendations
• Coordinates litigation case management to ensure cost containment; attend trials when needed, reports on trial to management, ensures clear and concise communication between defense attorney and management
• Manages incident reports and determine appropriate action plan
• Communicates with all partners, customers and other third parties who have filed an incident report to determine an appropriate action plan and to provide the best possible customer service
• Reviews reports, makes initial contact with partner, determines eligibility for benefits on work injuries, and administers all benefits due in accordance with the with the provisions of the Work Injury Benefit Plan, including coordination of the Return to Work (RTW) Program
• Facilitates subrogation / recovery efforts from third parties responsible
• Continuously reviews, sets and monitors reserves to reflect appropriate levels of exposure
• Reviews and approves payments on all cases within assigned authority
• Ensure adequate communication and resolution on attorney represented or litigated cases
• Negotiates and diffuses claims with third parties and plaintiff Attorneys
• Serves as corporate representative, witness, etc. as necessary
• Facilitates property claims, work injury and general liability
• Instills a safety culture and supports all safety initiatives
• Demonstrates proficiency in training of Risk Solutions initiatives
• Performs other functions pertinent to this job as assigned
• Creates, runs, analyzes, and communicates incident trends reports for Operations Leadership

The responsibilities and essential functions outlined above describe the general nature and level of work assigned to this position. This is not an exhaustive list of all duties, responsibilities, and skills required. Duties and responsibilities may be modified at any time based on business needs. Employees may be required to perform other job-related tasks as requested by their supervisor, subject to reasonable accommodations.

Qualifications & Key Requirements

Work Experience

• 2+ years Related experience
• 2-5 years claims handling experience (case management involving medical, vocational, subrogation / recovery, return to work program, etc.)

Knowledge/Skills/Abilities

• Ability to interface with regulatory agencies, division and corporate staff, professional associations and other organizations
• Excellent customer service skills
• Excellent telephone skills
• Bilingual preferred (English & Spanish)
• Moderate PC skills, including Microsoft Office Software and a Claims Management System
• Working knowledge of PPO utilization, medical terminology, etc.
• Understanding of project management process

Education

• Bachelor’s Degree or comparable formal training, certification, or work experience

Licenses/Certifications

• Current "All-Lines" Claims Adjuster license through the Texas Department of Insurance - Required
• Valid Texas driver license, no DUI, and no more than 2 moving violations in last 2 years

Physical Demands & Working Conditions

• Function in a fast-paced, retail, office environment
• Travel by car or plane with overnight stays
• Lift 20 lbs or more on an occasional basis
• Work extended hours
• Sit for an extended period of time
• Hand / Finger dexterity
• Available for emergency contact 24 hours a day

The work environment characteristics described here are representative of those a Partner encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Last revised: 09/1/2024