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Worker's Compensation Claims Adjuster Specialist I

2 months ago

Quincy, United States Retail Business Services Full time
Address: USA-MA-Quincy-1385 Hancock Street
Store Code: Claims Management (2762221)

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.

Primary Purpose

This role is responsible for the timely, good faith adjustment and disposition of self-administered casualty claims in multiple jurisdictions. Responsibility extends to all aspects and phases of investigations to determine compensability or liability, evaluations, negotiations, and settlements/denials of the following claims: workers' compensation, general liability, and auto liability. This role has direct responsibility for managing the claim in its entirety while maintaining service and quality level targets. 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.

Principle Duties and Responsibilities
  • Provides professional, technical, and strategic guidance for the management of claims using regulatory knowledge, familiarity with company policies and Human Resources practices.
  • Conducts investigations on assigned 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 the lowest cost.
  • Represents the Brands in the litigation process of claims by attending mediation/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.
  • Manage book of claims business (up to $10 million Gl, $20 million WC) with authority to settle/negotiate a single claim within their authority of up to $100,000.00 (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.
Basic Qualifications
  • Licensed adjuster (as appropriate by authority).
  • Bachelor's degree or a minimum of 5 years' experience handling large caseload of complex, high dollar, litigated claims.
  • Thorough knowledge of legal procedures and processes involved in handling claims.
  • Thorough knowledge of rules, regulations, statutes, and procedures pertaining to workers' compensation and general liability claims.
  • Knowledge of coaching principles and practices.
  • Knowledge of medical terminology is involved in complex claims.
  • Knowledge of customer relations principles and techniques.
  • Prominent level of negotiation, analytical, planning, influence, communication, and presentation skills.
  • Proven leadership and management skills, with the ability to work with all levels of management.
  • Mature level of knowledge for company, business, and industry practices
Preferred Qualifications
  • Certification (AIC)
  • Experience in risk management, self-administered programs and/or insurance matters.
  • Advanced claims management techniques.
#LI-SM1

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. When considered together, the companies of Ahold Delhaize USA comprise the largest grocery retail group on the East Coast and the fourth largest grocery retail group in the nation, serving millions of omnichannel customers each week.

Job Requisition: 381190_external_USA-MA-Quincy_652024

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