Claims Professional

Job Description

Job Title: Claims Professional

Location: Corporate

Department: Risk Management

Job Summary: The Claims Professional will handle claims in their book of business to ensure claims are closed in the most efficient manner and time while being handled within Wawa’s established SOPs. Claims Analyst III will be the main point of contact for TPA adjusters under their book of business and oversee all communications within Wawa to ensure proper claim handling and follow-up. In this position approximately 80% of claims assigned should be autonomously managed.

Principal Duties:

• Act as the Main Point of Contact (MPOC) for TPA Adjusters. Oversee the quality of service provided by the TPA vendor for your claims to ensure SPOs are being followed, the “Wawa Way” is being implemented, and claims are handled following the Special Service Instructions (SSI) by the TPA.
• Review materials gathered during the claims investigation to determine Wawa’s level of Risk Exposure and proper course of action to close claim in a timely manner.
• Early detection and elevation of potentially complex claims when needed to Senior Management.
• Set/Approve settlement and/or reserves within your authority for each claim and elevate to more senior Claims Analyst or Risk Management leadership as needed to secure proper reserves.
• Participate in the committee to evaluate and manage external Legal Counsel Panel.
• Assign Defense Counsel from the established legal counsel panel as per SOPs when needed.
• Meet with TPA adjusters regularly to review claims within your book of business.
• Document and take/request corrective action with TPA Claims managers, TPA Account Manager, when needed to correct inappropriate or lack of action of any TPA Adjuster.
• Oversee the completion of interrogatories in conjunction with External Counsel. Act as Signatory for the submitted interrogatories on behalf of Wawa.
• Act as the MPOC for store management or associate’s questions
• Serve as primary contact with Call Center to provide input to ensure quality claim reporting and customer service.
• Strategize for and attend arbitration, mediation, settlement conferences, or trials as needed.
• Review and approve request from TPA to assign investigative and expert services within SOP guidance.
• Identify trends that are causing claims to occur and elevate them to Risk Management Leadership.
• Participate in Safety Committee meetings.
• Undertake and lead projects when required.
• Perform other tasks and duties as assigned.

Essential Functions:

·       Ability to work well individually as well as in a team environment

·       Excellent oral and written communication skills

·       Excellent customer service skills

·       Ability to work with little or no supervision

·       Detail oriented and strong organizational skills

·       Strong analytical and problem-solving skills

·       Ability to handle multiple projects

·       Excellent interpersonal skills

·       Proven self-starter with demonstrated ability to make decisions

·       Ability to accept tasks and direction and to bring tasks to a timely conclusion

·       Desire to gain valuable claim experience in multi-lines of coverage

• Ability to handle incident and injury descriptions, photos, and videos that may be graphic in nature

·       Ability to keep confidentiality

Basic Qualifications:

·       Bachelor’s Degree in a related field preferred (Risk Management, Finance, Criminal Justice)

·       2-4 years working in worker’s compensation or liability insurance claims environment required

·       Ability to use multiple systems to review adjuster notes and run loss reports

·       Expert usage of Microsoft Office (M365)

Wawa will provide reasonable accommodation to complete an application upon request, consistent with applicable law. If you require an accommodation, please contact our Associate Service Center at [email protected].

Wawa, Inc. is an equal opportunity employer. Wawa maintains a work environment in which Associates are treated fairly and with respect and in which discrimination of any kind will not be tolerated. In accordance with federal, state and local laws, we recruit, hire, promote and evaluate all applicants and Associates without regard to race, color, religion, sex, age, national origin, ancestry, familial status, marital status, sexual orientation or preference, gender identity or expression, citizenship status, disability, veteran or military status, genetic information, domestic or sexual violence victim status or any other characteristic protected by applicable law. Unlawful discrimination will not be a factor in any employment decision.