Risk Solutions Rep - Claims Adjuster (Houston Region)

Responsibilities

Job Summary: As a Risk Solutions Representative, you'll manage and administer Risk Solutions Programs with the guidance of Risk Leadership: Work Injury Benefit Plan, Return-to-Work Benefit Plan, Premises and Products Liability Program, and Loss Prevention Litigation. You'll handle claims and conducts litigation management. Facilitate safety initiatives with assigned stores / locations within OSHA regulations.

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Key Responsibilities & Essential Functions:

• Conducts investigations on all types of claims and RTW cases and provides recommendation for best course of action
• Reviews and interprets existing, new or proposed OSHA and other federal and state regulations, updates to department staff as necessary
• Investigates and documents hazard reviews; analyzes, evaluates and presents recommendations
• Coordinates litigation case management to ensure cost containment; attend trials when needed, reports on trial to management, ensures clear and concise communication between defense attorney and management
• Manages incident reports and determine appropriate action plan
• Communicates with all partners, customers and other third parties who have filed an incident report to determine an appropriate action plan and to provide the best possible customer service
• Reviews reports, makes initial contact with partner, determines eligibility for benefits on work injuries, and administers all benefits due in accordance with the with the provisions of the Work Injury Benefit Plan, including coordination of the Return to Work (RTW) Program
• Facilitates subrogation / recovery efforts from third parties responsible
• Continuously reviews, sets and monitors reserves to reflect appropriate levels of exposure
• Reviews and approves payments on all cases within assigned authority
• Ensure adequate communication and resolution on attorney represented or litigated cases
• Negotiates and diffuses claims with third parties and plaintiff Attorneys
• Serves as corporate representative, witness, etc. as necessary
• Facilitates property claims, work injury and general liability
• Instills a safety culture and supports all safety initiatives
• Demonstrates proficiency in training of Risk Solutions initiatives
• Performs other functions pertinent to this job as assigned
• Creates, runs, analyzes, and communicates incident trends reports for Operations Leadership

The responsibilities and essential functions outlined above describe the general nature and level of work assigned to this position. This is not an exhaustive list of all duties, responsibilities, and skills required. Duties and responsibilities may be modified at any time based on business needs. Employees may be required to perform other job-related tasks as requested by their supervisor, subject to reasonable accommodations. xhyhwjd

Qualifications & Key Requirements: Work Experience:

• 2+ years Related experience
• 2-5 years claims handling experience (case management involving medical, vocational, subrogation / recovery, return to work program, etc.)

Knowledge/Skills/Abilities:

• Ability to interface with regulatory agencies, division and corporate staff, professional associations and other organizations
• Excellent customer service skills
• Excellent telephone skills
• Bilingual preferred (English & Spanish)
• Moderate PC skills, including Microsoft Office Software and a Claims Management System
• Working knowledge of PPO utilization, medical terminology, etc.
• Understanding of project management process

Education:

• Bachelor's Degree or comparable formal training, certification, or work experience

Licenses/Certifications:

• Current "All-Lines" Claims Adjuster license through the Texas Department of Insurance - Required
• Valid Texas driver license, no DUI, and no more than 2 moving violations in last 2 years

Physical Demands & Working Conditions:

• Function in a fast-paced, retail, office environment
• Travel by car or plane with overnight stays
• Lift 20 lbs or more on an occasional basis
• Work extended hours
• Sit for an extended period of time
• Hand / Finger dexterity
• Available for emergency contact 24 hours a day

The work environment characteristics described here are representative of those a Partner encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Last revised: 09/1/2024