Workers' Compensation Analyst III Claims Adjuster

ViziRecruiter,LLC.; Quincy (MA); Hybrid; USD 60,000 - 100,000; Full time

Job summary

A recruitment firm in the USA seeks a Claims Manager to oversee complex Workers' Compensation claims with a focus on high dollar and litigated cases. The role requires a Bachelor's degree or significant experience in claims management and involves mentoring Analysts, providing technical guidance, and managing claims of substantial financial impact. The company offers a flexible hybrid work schedule and values strong interpersonal and negotiation skills in candidates.

Qualifications

• Licensed adjuster as appropriate by jurisdiction.
• Thorough knowledge of Workers' Compensation laws and procedures.
• Knowledge of medical terminology involved in complex claims.
• Experience in handling complex, high dollar, litigated claims.

Responsibilities

• Manages complex claims with emphasis on high dollar and litigated claims.
• Provides technical guidance on claims management.
• Conducts investigations on assigned claims and creates action plans.
• Mentors Analysts on adherence to claims standards.

Skills

Excellent interpersonal skills

Ability to multi-task

Excellent time management skills

High level of negotiation skills

Analytical skills

Planning skills

Influence skills

Communication skills

Presentation skills

Leadership and management skills

Education

Bachelor's degree or 7 years' experience

Industry Designation (AIC, ARM, CPCU)

Job description

Introduction

Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which also includes five leading omnichannel grocery brands – Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Ahold Delhaize USA associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more.

Overview

Manages complex claims with special emphasis on high dollar and litigated claims. Ensures compliance with state laws and company policies along with mentoring assigned Analysts regarding basic claims standards and department policies. Provides support and assistance in the implementation and maintenance of programs designed to reduce costs and achievement of best-in-class status.

Our flexible/hybrid work schedule includes 1 in-person day at one of our core locations and 4 remote days.

Applicants must be currently authorized to work in the United States on a full-time basis.

Responsibilities

• Provides professional, technical and strategic guidance for the management of WC claims using regulatory knowledge, familiarity with company policies and Human Resources practices.
• Conducts investigations on assigned Workers' Compensation claims, creates action plans for resolution, evaluates financial exposure and sets appropriate reserves.
• Directs, advises, and supports Company associates and all levels of management on technical aspects of claims management in a cost-effective manner.
• Assigns and directs the efforts of outside resources including attorneys, rehabilitation counselors and investigators. Develops partnerships to maximize service at lowest possible cost.
• Represents the Brands in the litigation process of claims by attending mediations/hearings while serving as a specific technical expert for internal management staff.
• Mentors Analysts in adherence to claims standards, time management skills department policies and requirements of best-in-class status.
• Effectively communicates with all levels of internal management and outside professionals.
• Work in a collaborative manner while maintaining confidentiality of complex and sensitive subjects.

Financial Impact Administration

• Manage book of claims business ($100 million WC) with authority to settle/negotiate a single claim within their authority of up to $125,000.00 (Corporate Authority policy).
• Communicate ongoing causes and trends of GL/WC injuries to Safety and Brands.
• Serve as the primary point of contact to address and resolve claim issues impacting customer, 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.

Requirements

• Licensed adjuster (as appropriate by jurisdiction).
• Bachelor's degree or a minimum of 7 years' experience handling large caseload of complex, high dollar, litigated claims.
• Industry Designation (AIC, ARM, CPCU, etc.).
• Thorough knowledge of rules, regulations, statutes and procedures pertaining to Workers' Compensation.
• Thorough knowledge of legal procedures and processes involved in handling claims.
• Thorough knowledge of Medicare regulations as they apply to WC.
• Knowledge of coaching principles and practices.
• Knowledge of medical terminology involved in complex claims.
• Knowledge of customer relations principles and techniques.

Preferred Qualifications

• Juris Doctorate/Paralegal with specialty in Workers Compensation.
• Experience in risk management, self-administered programs, captives and/or insurance matters.
• Advanced claims management techniques.

Skills & Abilities

• Excellent interpersonal skills.
• Ability to multi-task.
• Excellent time management skills.
• High level of negotiation, analytical, planning, influence, communication, and presentation skills.
• Proven leadership and management skills, with ability to work with all levels of management.
• Mature level of knowledge for company, business, and industry practices.
• Demonstrates a personal acceptance of change and the ability to adapt and drive change.