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The Save Mart Companies · 15 hours ago

Claims Manager - Modesto, CA

Modesto, CA

Full-time

Onsite

Mid, Senior Level

$81K/yr - $98K/yr

5+ years exp

The Save Mart Companies is California’s largest regional, full-service grocery chain, founded over 70 years ago. The Claims Manager investigates, evaluates, and manages all workers' compensation, general liability, and insurance claims, ensuring compliance with regulations and collaborating with various stakeholders to resolve claims effectively.

DairyFood and BeverageRetail

Responsibilities

Investigates claims through evidence gathering, witness interviews, incident report review, and documentation of claim circumstances

Evaluates claim validity and compensability by analyzing whether injuries arose out of and in the course of employment for workers' compensation claims and assessing company legal liability for general liability claims

Establishes and adjusts claim reserves based on severity, exposure, and historical loss data as claims develop

Ensures timely reporting of claims to insurance carriers, third-party administrators, and regulatory agencies within statutorily required timeframes

Maintains compliance with state-specific workers' compensation laws across California and Nevada jurisdictions, including meeting all filing deadlines, attending required conferences and hearings, and responding to regulatory inquiries

Represents the company at legal proceedings, program audits, vendor meeting, along with regulatory and court hearings

Analyzes claim trends and root causes to identify patterns in incidents across the store portfolio, such as slip-and-falls in particular locations, repetitive motion injuries in specific departments, or customer incidents related to product handling. Based on analysis, develops and implements corrective action plans and preventive measures. Coordinates with store operations, facilities, and safety teams to address hazardous conditions, implements training programs, and modifies procedures to reduce future claim frequency and severity

Works with retail, logistic, back-office support and corporate management on risk awareness on various policies and procedures

Communicates with employees and management on a regular basis about the needs and changes of the insured claims programs

Oversees relationships with insurance carriers, third-party administrators, defense counsel, medical providers, and vendors. Selects and directs defense counsel for litigated claims, reviews legal bills for reasonableness, and monitors litigation strategy and outcomes. For workers' compensation, coordinates medical treatment, authorizes care within established guidelines, and works with medical case managers to facilitate appropriate treatment and return-to-work programs

For workers' compensation claims specifically, develops and implements modified duty and transitional work programs to return injured employees to work as quickly as medically appropriate. This involves coordinating with third-party administrators and store management to identify suitable temporary assignments, working with treating physicians to establish work restrictions, and monitoring employees' progress through recovery

Develops and updates claim service instruction for third party administrators

Controls claim costs through effective negotiation of settlements, medical bill review and negotiation, management of attorney fees and litigation expenses, and identification of subrogation opportunities. Prepares and manages the claims budget, tracks actual versus projected costs, and provides financial reporting on loss runs, claim reserves, and paid losses. Analyzes the financial impact of claims on insurance premiums and works to minimize experience modification rates

Provides training to store management and safety staff on proper incident reporting procedures, claims investigation techniques, and their roles in the claims process. Educates managers on what constitutes a compensable workers' compensation injury, when to report incidents, and how to document events accurately

Serves as the primary point of contact for injured employees, claimants, store management, corporate leadership, and insurance partners. Provides regular status updates to stakeholders, explains claims processes and procedures, and manages expectations regarding claim outcomes and timelines

Liaison with Safety Team to Counsel/work with employees and locations with high claims rates to evaluate in-store safety program administration

Works closely with the Safety team to develop safety programs that prevent injury or accidents, and ensure in-store safety programs are implemented and effective

Assists in the annual insurance renewal process and contribute to budget recommendations

Provides program and administrative support to Director of Risk Management; may represent Director at meetings, etc

May lead projects, as assigned to improve existing programs

Follows all safety policies and procedures

Other duties as assigned

Qualification

Workers' Compensation knowledgeGeneral Liability knowledgeClaims management experienceAnalytical skillsCalifornia insurance regulationsNevada insurance regulationsAdvanced Excel skillsPowerPoint proficiencyWord proficiencyCase management systems knowledgeBusiness intelligence platforms knowledgeCommunication skillsOrganizational skillsProblem-solving skillsPresentation skills

Required

5 years related experience

4 Year/Bachelors Degree and/or equivalent experience/training in Risk or Safety preferred

Knowledge of California and Nevada Workers Compensation regulations and time tables

Knowledge of California and Nevada insurance rules and regulations

Understanding of ADA process and implications under Workers Compensation

Understanding of OSHA, EPA, and Health Department regulations

Working knowledge of case management systems as it applies to developing job task analysis to assess employees for return to work

Excellent communication skills (verbal and written)

Excellent organizational skills

Strong problem-solving skills

Strong fact-finding skills

Strong presentation skills

Advanced skills in Excel, PowerPoint, and Word

Preferred

General knowledge of Commercial Auto, Property, Workers Compensation, General Liability coverages (CA and NV). A D&O, EPL, E&O and Surety understanding

Knowledge of business intelligence platforms for reporting would be a plus. Examples of these systems are Power BI, Tableau or Qlik