Case Manager I, Claims Management

Job description

Leads claim investigations by conducting ongoing medical and legal reviews commissioning field investigators reconstructionist and cause and origin specialists to determine claim origination managing media exposure during investigations synthesizing information from outside counsel and reviewing documenting and indexing information received on each claim in the claimimage management system. Handles monetary aspects of assigned claims by establishing reserves within approval level notifying store managers of significant reserve increases monitoring reserves for all open claims authorizing payment for approval or facilitating denial of the claim and reserving file for payments that exceed authority for manager and serious case review. Minimizes legal exposure by securing services of outside legal counsel attending and participating in arbitrations auditing and paying outside counsel invoices assessing the impact claim may have on case law and precedent prior to making claim payment and structuring complex settlements. Manages moderately complex cases involving alleged bodily injury personal injury and property damage by interviewing key witnesses securing evidence analyzing evidence reviewing applicable laws interpreting medical reports deducing causes and responsibilities documenting case details determining whether payment is warranted and managing multiple claims related to a single event as required. Manages interpretation of medical reports and case information reviewing records for preexisting conditions referencing applicable case law statutes and presenting claim reviews and decisions to senior management for approval or guidance. Manages negotiations with customer customers attorney or third party to resolve claims by sharing investigative results and rationale listening to claimant perspective and arguments influencing claimants' perspective and coming to consensus on appropriate and final resolution. Coordinates, completes and oversees job-related activities and assignments by developing and maintaining relationships with key stakeholders supporting plans and initiatives to meet customer and business needs identifying and communicating goals and objectives building accountability for and measuring progress in achieving results identifying and addressing improvement opportunities and demonstrating adaptability and promoting continuous learning. Provides supervision and development opportunities for associates by hiring and training mentoring assigning duties providing recognition and promoting a belonging mindset in the workplace. Ensures compliance with company policies and procedures and supports company mission values and standards of ethics and integrity by implementing related action plans utilizing and supporting the Open Door Policy: and providing direction and guidance on applying these in executing business processes and practices. Respect the individual: Demonstrates and encourages respect for others drives a positive associate and customer member experience for all embraces differences in people cultures ideas and experiences supports workplaces where associated feel seen and connected through a culture of belonging so all associates thrive and perform contributes to an environment allowing everyone to bring their best selves to work. Respect the individual: Demonstrates engagement and commitment to the team developing others through feedback coaching mentoring and developmental opportunities and recognizes other's contributions and accomplishments. Respect the individual: Builds strong and trusting relationships with team members and business partners works collaboratively to achieve objectives communicates with impact and listens attentively to a range of audiences and demonstrates energy and positivity for own work. Act with Integrity: Maintains and promotes the highest standards of integrity ethics and compliance models the Walmart values and leads by example to foster our culture supports Walmart's goal of becoming a regenerative company by making a positive impact for associates customers and the world around us eg creating a sense of belonging eliminating waste participating in local giving. Act with Integrity: Follows the law our code of conduct and company policies and encourages others to do the same supports an environment where associates feel comfortable sharing concerns reinforces our culture of nonretaliation listens to concerns raised by associates and takes action acts with accountability for achieving results in a way that is consistent with our values. Act with Integrity: Is consistently humble self-aware honest and transparent. Serve our Customers and Members Delivers results while putting the customer member first and applying an omni merchant mindset and acts with an Every Day LowCost mindset to drive value and Every Day Low Prices for customers members. Serve our Customers and Members Adopts a broad perspective that considers data analytics customer member insights and different parts of the business when making plans. Strive for Excellence: Consistently raises the bar and seeks to improve demonstrates curiosity and a growth mindset seeks feedback asks thoughtful questions support innovation and intelligent risk-taking and exhibits resilience in the face of setbacks. Strive for Excellence: Implements and supports continuous improvements and willingly embraces new digital tools and ways of working. Bachelor's degree OR 2 years’ experience in insurance claims or related area Settling claims and customer service All your information will be kept confidential according to EEO guidelines.