Case Manager II, Claims Management

Position Summary... What you'll do... Role summary: The (USA) Case Manager II, Claims Management, is responsible for managing mid-complexity workers’ compensation and general liability claims throughout the claim lifecycle. This role involves reviewing claim reports, determining compensability, authorizing medical treatment, and negotiating resolutions while ensuring compliance with regulatory standards. The position requires establishing accurate reserves, escalating cases as needed, and collaborating with stakeholders to achieve timely outcomes. The Case Manager II supports continuous improvement initiatives and delivers exceptional service by applying expertise in claims investigations, resolution, and case management within established authority limits. About the team: The Claims Management team handles mid-complexity product general liability claims with a focus on thorough investigation, evaluation, and resolution. Team members manage active caseloads, ensuring compliance with regulatory standards and company policies. They collaborate closely with stakeholders to deliver timely, accurate outcomes while maintaining high ethical standards. The team supports continuous improvement through strategic initiatives and effective communication. Expertise in claims investigations, resolution, and case management is essential to uphold service quality and operational excellence, contributing to a reliable and efficient claims process within the organization. What you'll do: Review and analyze initial claim reports to determine compensability and compliance with jurisdictional statutes. Manage a caseload of mid-complexity workers’ compensation and general liability claims throughout the claim lifecycle. Establish and monitor reserves within authority limits, escalating cases exceeding thresholds. Authorize and oversee medical treatment to ensure necessity and appropriateness. Calculate wages and issue indemnity payments in accordance with regulations. Communicate effectively with claimants and stakeholders to facilitate claim resolution. Negotiate settlements and present claims in review forums to secure approvals. Identify potential fraud indicators and elevate as required. Maintain compliance with regulatory and internal policies while supporting continuous improvement initiatives. What you'll bring: Proven experience managing mid-complexity workers’ compensation or general liability claims throughout the claim lifecycle. Strong skills in claims investigations, resolution, and case management aligned with jurisdictional statutes and regulatory requirements. Ability to establish accurate reserves and adjudicate claims within assigned financial authority. Proficiency in authorizing and monitoring medical treatment using Official Disability Guidelines and nurse resources. Effective communication and negotiation skills to resolve claims with associates, customers, or attorneys. Commitment to compliance with company policies, ethics, and regulatory standards. Capacity to support strategic initiatives and continuous improvement in claims outcomes. At Walmart, we offer competitive pay as well as performance-based bonus awards and other great benefits for a happier mind, body, and wallet. Health benefits include medical, vision and dental coverage. Financial benefits include 401(k), stock purchase and company-paid life insurance. Paid time off benefits include PTO (including sick leave), parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more. You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive depends on your job classification and length of employment. It will meet or exceed the requirements of paid sick leave laws, where applicable. For information about PTO, see Live Better U is a Walmart-paid education benefit program for full-time and part-time associates in Walmart and Sam's Club facilities. Programs range from high school completion to bachelor's degrees, including English Language Learning and short-form certificates. Tuition, books, and fees are completely paid for by Walmart. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to a specific plan or program terms. For information about benefits and eligibility, see One.Walmart. The annual salary range for this position is $70,000.00 - $130,000.00. Additional compensation includes annual or quarterly performance bonuses. Additional compensation for certain positions may also include : - Stock Minimum Qualifications... Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications. Option 1: High school diploma, GED, or equivalent and 1 year’s experience in claims management, insurance operations, or related area. Option 2: 3 years’ experience in claims management, insurance operations, or related area. Current or prior (within last 3 years) Property & Casualty Adjuster License. Preferred Qualifications... Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications. Bachelor’s degree in Risk Management, Insurance, Business Administration, Legal Studies, or related field. experience in settling claims and customer service., Industry designations (e.g., AIC, WCCP). Primary Location... 905 Customer Dr, Bentonville, AR 72716, United States of America Walmart and its subsidiaries are committed to maintaining a drug-free workplace and has a no tolerance policy regarding the use of illegal drugs and alcohol on the job. This policy applies to all employees and aims to create a safe and productive work environment. #J-18808-Ljbffr