Senior Workers' Comp Claims Analyst - Hybrid (1 day in-office)

Adusa; Salisbury (NC); Hybrid; USD 63,000 - 95,000; Full time

Job summary

Ahold Delhaize USA is seeking an Analyst II to manage a caseload of incident-only, medical-only, and lost-time Workers' Compensation claims across multiple jurisdictions, ensuring timely, compliant resolution and returning injured associates to work.

This hybrid role supports Store Management, Distribution, Transportation, and HR, coordinating with vendors and healthcare providers to optimize outcomes while safeguarding confidentiality.

Qualifications

• Minimum 5 years of Workers' Compensation claims adjudicating experience, including lost-time claims.
• Active adjuster license(s), as required by jurisdiction, or ability to obtain.
• Bachelor's degree or equivalent professional experience.
• 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.
• Conduct timely investigations to determine compensability, evaluate exposure, and develop appropriate claim strategies.
• Negotiate and manage settlements within assigned authority. Authority levels vary by experience.
• Actively manage medical treatment to minimize disability duration and promote 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.
• Coordinate with PBM partners to monitor prescriptions and ensure medications are injury-related.
• Identify potential fraud indicators and escalate concerns in accordance with established protocols.
• Communicate clearly and professionally with associates, medical providers, attorneys, and vendors while maintaining strict confidentiality.

Skills

Negotiation

Investigations

Claims adjudication

Communication

Education

Bachelor's degree

Job description

Ahold Delhaize USA is seeking an Analyst II to manage a caseload of incident-only, medical-only, and lost-time Workers' Compensation claims across multiple jurisdictions, ensuring timely, compliant resolution and returning injured associates to work.

This hybrid role supports Store Management, Distribution, Transportation, and HR, coordinating with vendors and healthcare providers to optimize outcomes while safeguarding confidentiality.