Case Manager I, Workers' Compensation

Job description

All your information will be kept confidential according to EEO guidelines. Job Description Manages monetary aspects of assigned claims by establishing appropriate reserves and authorizing payment or facilitating denial of the claim; engaging in negotiations with minimal supervision. Provides service to customers by sharing information; discussing resolution strategies with counsel; developing relationships with support areas; and providing guidance or suggestions to customers on alternate strategies, reserve assessment, and how to handle complex situations. Manages moderately complex workers' compensation claims by investigating facts of the case; determining compensability; evaluating medical records and physician recommendations; utilizing medical and legal resources; communicating with physicians to seek clarification or to question medical treatment; obtaining independent medical examinations; identifying pre-existing injury or possibility of fraud; utilizing appropriate business writing techniques in reviewing, documenting, and indexing information and mail within the claim management system; reviewing potential settlements; determining probable exposure if any; and establishing appropriate reserves. Monitors associate disability management to ensure costs are appropriate by tracking serious injuries and recovery; analyzing exposure; compiling and reviewing documents and evidence; evaluating back-to-work issues; developing back-to-work action plans with physicians and store staff; negotiating with injured associates and legal or state board representatives; requesting medical records and billing documents; determining if payment is warranted to medical providers and/or injured associates; and ensuring payment is made. Participates in moderately complex case reviews by reviewing files; summarizing facts; completing standardized forms; identifying legal issues; presenting claim information and possible exposure to senior management; offering recommendations to address issues, settlements, and reserve changes; and occasionally participating in depositions and arbitrations. Provides and supports the implementation of business solutions by building relationships and partnerships with key stakeholders; identifying business needs; determining and carrying out necessary processes and practices; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and adapting to competing demands, organizational changes, and new responsibilities. Models compliance with company policies and procedures and supports company standards of ethics and integrity by incorporating these into the development and implementation of business plans; using the Open Door Policy; and demonstrating and assisting others with how to apply these in executing business processes and practices. Demonstrates up-to-date expertise and applies this to the development, execution, and improvement of action plans by providing expert advice and guidance to others in the application of information and best practices; supporting and aligning efforts to meet customer and business needs; and building commitment for perspectives and rationales. Live our Values Culture Champion • Models the Walmart values to foster our culture; holds oneself and others accountable; and supports Walmart’s commitment to communities, social justice, corporate social responsibility, and sustainability; maintains and promotes the highest standards of integrity, ethics and compliance. Servant Leadership • Acts as an altruistic servant leader and is consistently humble, self-aware, honest, and transparent. Embrace Change Curiosity & Courage • Demonstrates curiosity and a growth mindset; fosters an environment that supports learning, innovation, and intelligent risk-taking; and exhibits resilience in the face of setbacks. Digital Transformation & Change • Seeks and implements continuous improvements and encourages the team to leverage new digital tools and ways of working. Deliver for the Customer Customer Focus • Delivers expected business results while putting the customer first and consistently applying an omni-merchant mindset and the EDLP and EDLC business models to all plans. Strategic Thinking • Adopts a holistic perspective that considers data, analytics, customer insights, and different parts of the business when making plans and shaping the team’s strategy. Focus on our Associates Diversity, Equity & Inclusion • Identifies, attracts, and retains diverse and inclusive team members; builds a high-performing team; embraces diversity in all its forms; and actively supports diversity goal programs. Collaboration & Influence • Builds strong and trusting relationships with team members and business partners; works collaboratively and cross-functionally to achieve objectives; and communicates with energy and positivity to motivate, influence, and inspire commitment and action. Talent Management • Creates a discipline and focus around developing talent, promotes an environment allowing everyone to bring their best selves to work, empowers associates and partners to act in the best interest of the customer and company, and regularly recognizes others’ contributions and accomplishments.