Risk Claims Specialist

Job Description

Job Description

Key Responsibilities:

Customer Claims:
• Manage Customer Injury and Liability Claims: Oversee the investigation, documentation, and resolution of customer claims related to personal injury, property damage, or any other incidents occurring on organization premises.
• Coordinate with Insurance Providers: Liaise with insurance companies to ensure proper claims filing and coordinate the resolution of claims involving external parties.
• Customer Support: Handle escalated customer claims and provide appropriate resolutions while ensuring the store’s best interests are maintained.
• Documentation & Compliance: Ensure that all claims are properly documented in compliance with company policies and legal requirements. Keep detailed records of each customer-related claim.
• Risk Prevention: Identify trends or recurring incidents that may contribute to customer claims and work with store management to implement safety measures or preventive actions.

Employee Claims:
• Workers' Compensation Claims: Oversee and manage all workers’ compensation claims, ensuring compliance with state and federal regulations, and ensuring employees receive appropriate benefits.
• Workplace Injury Claims: Manage the investigation of employee injury claims, including gathering evidence, interviewing witnesses, and ensuring all necessary forms are completed and submitted on time.
• Fleet Claims Management: Manage the investigation of employee fleet claims, support employee’s injuries if any, gather witness statements
• Support and Guidance: Provide support to injured employees, ensuring they are informed throughout the claims process and are aware of their rights and available benefits.
• Collaboration with HR and Legal: Work with HR and legal teams to ensure employee-related claims are handled correctly and in compliance with labor laws, insurance regulations, and company policies.
• Collaboration with Safety Team: Work with the Safety Team to consistently do store visits, conduct safety audits, checklists and investigations as needed.
Development:
• Process Improvement: Identify opportunities to improve the claims process, whether through more efficient systems, better documentation, or enhanced communication strategies.

Risk Management and Reporting:
• Claims Analysis and Reporting: Review and analyze the data on claims to identify trends, recurring issues, or areas for improvement. Prepare detailed reports for management regarding claim frequency, costs, and risk mitigation efforts.
• Collaboration with Risk and Safety Teams: Work closely with the Risk Management and Safety teams to address underlying causes of incidents that may lead to claims and develop preventive strategies.
• Compliance: Ensure that all claims are processed in line with company policies, industry standards, and legal requirements, including managing documentation for audits or regulatory reviews.
• Invoices: Reconcile and verify all invoices generated from claims.
• Safety Monitor Report: Complete Safety Monitor report and communicate all parties involved to resolve an issue related to an investigation.

Qualifications:
• Bachelor’s degree in Business, Risk Management, Insurance, or a related field (or equivalent experience).
• 3-5 years of experience in claims management, risk management, or a specialist role, preferably
in a retail or supermarket environment.
• Strong understanding of risk management principles, insurance claims processes, and workers’ compensation regulations.
• Strong problem-solving and analytical abilities to investigate and resolve complex claims efficiently.
• Excellent communication skills, both written and verbal, with the ability to manage sensitive issues with customers and employees.
• Attention to detail and ability to maintain accurate records and reports.
• Proficient in Microsoft Office and experience with claims management software or risk management tools.

Physical Requirements:
• Ability to stand for extended periods
• Ability to lift up to 50 lbs as needed

Work Environment:
• Fast-paced, high-volume environment
• Occasional evening, weekend, or holiday work may be required
• Occasional travel to different company locations

Physical Demands:
Some lifting, carrying, pushing, and/or pulling; some stooping, kneeling, crouching, and/or crawling; and significant fine finger dexterity. Generally, the job requires 70% sitting, 20% walking, and 10% standing.

This job is performed in a generally clean and healthy office environment.