Case Manager I, Claims Management

Case Manager I, Claims Management

The Case Manager I is responsible for investigating, evaluating, and resolving low complexity workers' compensation or general liability claims.

What you'll do

Claims Management

• Secure and maintain the required licensure required by the state(s).
• Manage an active caseload of up to 140 low complexity workers' compensation or general liability claims.
• Secure and review initial claim reports, gather information, facts, and evidence to determine compensability or negligence in accordance with state specific statutes.
• Identify and escalate potential fraudulent claims.
• Identify and escalate claims with Early Claims Assessment (ECA) potential.
• Communicate with injured associates or customers that have sustained minor bodily injury or property damage with empathy and help them navigate the claims process.
• Establish timely and accurate reserves on claims; Escalate claims to the Claims Manager if claim value exceeds reserve authority.
• Adjudicate claims within reserve authority up to $35,000; Payment authority $2,500.
• Authorize and approve payment for reasonable and related medical treatment or damages.
• Negotiate and resolve claims with associates and customers.
• Issue settlement payments within authority limit; Escalate claims to the Claims Manager if payment exceeds authority.
• Escalate claims with increasing complexity or litigation potential to the Claims Manager.
• Meet or exceed goals on key performance metrics.
• Ensure compliance with all regulatory, jurisdictional, and internal standard operating procedures.
• Deliver exceptional customer service to injured associates, customers, the employer, and clients.
• Pass the adjuster licensing exam and obtain the state-issued adjuster license within required deadlines.

What you'll bring

Minimum Qualifications...

Insurance Adjuster license OR will obtain an Insurance Adjuster license within 30 days of job entry date.

Preferred Qualifications...

Bachelor's degree OR 2 years' experience in insurance claims or related area, Settling claims and customer service

Primary Location...

608 Sw 8Th St, Bentonville, AR 72712-6207, United States of America