Case Manager I, Claims Management
2 days ago
Walmart Global Tech is at the forefront of AI innovation, leveraging cutting-edge technologies to redefine customer experiences. We are seeking a Senior Machine Learning Engineer with deep expertise in Generative AI, LLMs, and scalable system design to drive impactful solutions.
Job Description
About the Team
Our Claims Management team is dedicated to delivering fair, timely, and empathetic resolution of workers' compensation and general liability claims, ensuring compliance with all regulatory requirements. We operate collaboratively, leveraging expertise and strategic initiatives to drive claim resolution and support injured associates and customers throughout the process
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...
- High School Diploma or GED required
- Strong organizational skills and the ability to manage time effectively in a fast-paced environment.
- Excellent verbal and written communication skills
- Prior claims, insurance, or customer service experience is preferred.
The above information has been designed to indicate the general nature and level of work performed in the role. It is not designed to contain or be interpreted as a comprehensive inventory of all responsibilities and qualifications required of employees assigned to this job. The full Job Description can be made available as part of the hiring process.
Additional Information
Imagine working in an environment where one line of code can make life easier for hundreds of millions of people. That's what we do at Walmart Global Tech. We're a team of software engineers, data scientists, cybersecurity expert's and service professionals within the world's leading retailer who make an epic impact and are at the forefront of the next retail disruption. People are why we innovate, and people power our innovations. We are people-led and tech-empowered. We train our team in the skillsets of the future and bring in experts like you to help us grow. We have roles for those chasing their first opportunity as well as those looking for the opportunity that will define their career. Here, you can kickstart a great career in tech, gain new skills and experience for virtually every industry, or leverage your expertise to innovate at scale, impact millions and reimagine the future of retail.
Flexible, hybrid work:
We use a hybrid way of working that is primarily in office coupled with virtual when not onsite. Our campuses serve as a hub to enhance collaboration, bring us together for purpose and deliver on business needs. This approach helps us make quicker decisions, remove location barriers across our global team and be more flexible in our personal lives.
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