Jr Workers Comp Adjuster

Title: Jr. WC Adjuster

Classification: Non-Exempt
Reports To: Risk Management Manager

Job Description

Position Summary

Provide hands-on team support under the general supervision of the Risk Management Manager. Responsible for assisting in the administration and management of workers' compensation medical and non-litigated indemnity claims through successful closure. Support the investigation, analysis, documentation, and coordination of workers' compensation claims while working closely with the Third-Party Administrator (TPA), injured employees, medical providers, and internal stakeholders.

Assist with monitoring claim activity, reviewing claim documentation, and supporting recommendations related to workers' compensation claim resolutions and settlements. Serve as a key resource for stores, warehouses, operations, and external medical providers. Be an integral member of the Risk Management team supporting the administration, implementation, and continuous improvement of Vallarta's Workers' Compensation Resolution Program and workplace safety initiatives. Actively support the company's goal of achieving World Class Safety standards.

General Duties and Responsibilities

• Be responsible for the claims intake and reporting process from beginning to end in accordance with standard operating procedures.
• Answer Risk Management's Claims Support phone line and respond to general and claim-related inquiries, including pre-screening potential new claims arising from stores.
• Follow up with stores to support the timely reporting and management of workers' compensation claims.
• Assist with the investigation, analysis, and management of workers' compensation medical and indemnity claims under the direction of the Risk Management Manager, including gathering information, reviewing documentation, monitoring claim activity, and supporting timely claim resolution.
• Assist in evaluating workers' compensation medical and indemnity claims and support claim resolution efforts.
• Assist the Risk Management Manager with active claim management, including follow-up communications, filing forms electronically and by mail, managing bills, maintaining claim files, identifying stale cases for closure consideration, and supporting other claims administration activities.
• Coordinate with TPAs, medical providers, employees, and internal stakeholders to obtain information necessary for claim management and return-to-work efforts.
• Proactively assist with managing Vallarta Supermarkets' health and safety programs and resources.
• Proactively assist with the training, development, and performance improvement of HR/Safety Compliance Specialists as needed.
• Manage health and safety management audit processes and perform regular assessments and audits of facilities and programs for compliance, including OSHA 300 log compliance.
• Maintain, update, and improve safety management performance metrics and generate timely reports for all levels of management.
• Train new managers and other personnel regarding safety management roles and responsibilities.
• Respond to requests for safety management support, resources, materials, and guidance.
• Support return-to-work programs and assist with maintaining related documentation and communications.

Knowledge, Skills, and Qualifications

Education

• High school diploma or equivalent required.
• Associate's degree or Bachelor's degree in Risk Management, Human Resources, Business Administration, Safety, or a related field preferred.

Experience

• 1-3 years of experience in workers' compensation claims, claims administration, risk management, human resources, safety, or a related field preferred.
• Experience with workers' compensation claims, claims management systems, medical records, return-to-work programs, or related claims administration activities preferred.
• Previous experience in customer service, workers' compensation, risk management, human resources, or related functions preferred.

Knowledge and Skills

• Ability to effectively communicate in both English and Spanish, including speaking, reading, and writing, is strongly preferred.
• Empathetic listening skills and a strong sense of curiosity.
• Ability to multitask and prioritize workload effectively.
• Highly organized and detail-oriented.
• Ability to work with minimal supervision and meet expectations.
• Ability to handle sensitive and confidential information appropriately.
• Ability to function in a fast-paced environment.
• Ability to travel as required by business necessity.
• Outstanding customer service skills.
• Excellent written and verbal communication skills.
• Proficient in Microsoft Office applications.
• Strong analytical and problem-solving skills.

Physical Demands

• Required to spend extended periods sitting and using office equipment and computers.
• May occasionally lift light office supplies and materials.
• Express and exchange ideas through spoken communication to provide information and instructions accurately, clearly, and effectively.
• Manage multiple tasks and situations simultaneously.
• Frequent phone interaction with internal and external customers.

Position Type / Expected Hours of Work

This is a non-exempt position; Monday through Friday, 8:00 a.m. to 5:00 p.m. (on-site). Schedule may vary based on business necessity. Must be willing to work mornings, weekends, and holidays when required and coordinated through the reporting supervisor.

This job description is not intended to be all-inclusive, and employees may perform other duties as directed. All employees are expected to perform any reasonable task or request consistent with fulfilling company goals and objectives.