Workers' Compensation Analyst II Claims Adjuster

Category/Area of Expertise: Legal
Job Requisition: 385078_external_USA-MA-Quincy
Address: USA-MA-Quincy-1385 Hancock Street
Store Code: Claims Management (2762221)

Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which also includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. Ahold Delhaize USA associates support the brands with a wide range of services, including Finance, Legal, Sustainability, Commercial, Digital and E-commerce, Technology and more.

Primary Purpose:
This role is responsible for the timely, good faith adjustment and disposition of self-administered casualty claims in multiple jurisdictions. Responsibility extends to all aspects and phases of investigations to determine compensability or liability, evaluations, negotiations and settlements/denials of Workers' Compensation claims. This role has direct responsibility for managing the claim in its entirety while maintaining service and quality level targets.
This role is responsible, specialized technical work investigating and processing claims for self-insured claims programs. This role is the primary claim interface to associates, attorneys, healthcare providers, vendor partners and Brand partners

Our flexible/hybrid work schedule includes 1 in-person day at one of our core locations and 4 remote days.

Applicants must be currently authorized to work in the United States on a full-time basis.

Principle Duties and Responsibilities:

Claims Management

• Manage assigned Workers Compensation caseload within established targets and financial authority. Performance standards include thorough investigations, evaluations, negotiation and disposition of all claims, while ensuring that all claims are in compliance with statutory and legal obligations.
• Monitor and ensure timely execution of all statutory deadlines or legal filings as needed.
• Analyze fact of the loss to understand the nature of the claim to develop strategies that provide optimal outcome and mitigate the overall Total Cost of Risk to the Brand bottom lines.
• Identify fraud indicators and actively pursue subrogation opportunities.
• Monitor and actively manage medical treatment with the goal of minimizing disability and fostering a successful re-entry to the workplace.
• Solid understanding of state and federal laws associated with employee relations, including, but not limited to: FMLA, and ADA,
• Closely monitor and manage prescriptions. Work with PBM to authorize prescriptions related to the injury.
• Collaborate with the Safety department in identifying hazards that exist in the retail and distribution operations and ways to minimize these risks.
• Build and maintain effective relationships with internal (Brands, Distributions Centers, Transportation, Ecommerce, Human Resources, Legal, Insurance) and external (vendors, healthcare providers, outside attorneys) customers.

Financial Impact Administration

• Manage book of Workers' Compensation claims business up to $5 million with authority to settle/negotiate a single claim within their authority of up to $75,000 (Corporate Authority policy)
• Communicate ongoing causes of associate or customer injuries to Safety and Brands.
• Serve as the primary point of contact to address and resolve claim issues impacting associate, vendor, and the Brands. Research and resolve claim/legal issues. Provide timely communication related to the claim, resolving issues, and responding to questions via phone, email, and online applications.

Basic Qualifications:

• Licensed adjuster (as appropriate by jurisdiction)
• Bachelor's degree or 4 years WC claims experience
• Thorough knowledge of rules, regulations, statutes and procedures pertaining to workers' compensation and general liability claims.
• Knowledge of medical terminology involved in complex claims
• Strong negotiation skills.
• Preferred experience in the following jurisdictions: MA, CT and RI

Skills and Abilities:

• Excellent interpersonal skills
• Ability to multi-task
• Attention to detail
• Excellent time management skills
• Strong analytical, planning, influence, communication, and presentation skills
• Demonstrates a personal acceptance of change and the ability to adapt and drive change
• Willingness and ability to train and mentor others
• Proficient in O365

#LI-SM1 #LI-Hybrid

Ahold Delhaize USA, a division of global food retailer Ahold Delhaize, is part of the U.S. family of brands, which also includes five leading omnichannel grocery brands - Food Lion, Giant Food, The GIANT Company, Hannaford and Stop & Shop. When considered together, the companies of Ahold Delhaize USA comprise the largest grocery retail group on the East Coast and the fourth largest grocery retail group in the nation, serving millions of omnichannel customers each week.