Claims Manager - Modesto, CA

Claims Manager - Modesto, CA The Claims Manager investigates, evaluates, and manages all workers' compensation, general liability, and insurance claims for the company. This position is responsible for documentation of claims and circumstances, investigation of claims, assessment of liability and compensability, establishment of reserves and settlement values, and processing of claims through to closure. The Claims Manager works closely with the Director of Risk Management to prepare and present claims for settlement or closure. The Claims Manager possesses advanced analytical skills to identify and assess risks that have an impact on the company's financial health, legal compliance, or reputation. The incumbent collaborates with Company Leadership, Department Managers, Legal staff, and third-party administrators (TPAs) to report, administer, and resolve claims effectively. Additionally, the Claims Manager works closely with insurance brokers and vendors on company projects and initiatives. This position requires analytical skills and knowledge to review operational procedures, business data, loss trends, and present findings to internal and external stakeholders. The incumbent must possess strong knowledge of Workers' Compensation, General Liability and insurance regulations in California and Nevada, along with demonstrated experience in claims management and reserve setting. Responsibilities: Investigate claims through evidence gathering, witness interviews, incident report review, and documentation of claim circumstances. Evaluate 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. Establish and adjust claim reserves based on severity, exposure, and historical loss data as claims develop. Ensure timely reporting of claims to insurance carriers, third-party administrators, and regulatory agencies within statutorily required timeframes. Maintain 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. Represent the company at legal proceedings, program audits, vendor meetings, along with regulatory and court hearings. Analyze 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, develop and implement corrective action plans and preventive measures. Coordinate with store operations, facilities, and safety teams to address hazardous conditions, implement training programs, and modify procedures to reduce future claim frequency and severity. Work with retail, logistic, back-office support and corporate management on risk awareness on various policies and procedures. Communicate with employees and management on a regular basis about the needs and changes of the insured claims programs. Oversee relationships with insurance carriers, third-party administrators, defense counsel, medical providers, and vendors. Select and direct defense counsel for litigated claims, review legal bills for reasonableness, and monitor litigation strategy and outcomes. For workers' compensation, coordinate medical treatment, authorize care within established guidelines, and work with medical case managers to facilitate appropriate treatment and return-to-work programs. For workers' compensation claims specifically, develop and implement 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. Develop and update claim service instruction for third party administrators. Control claim costs through effective negotiation of settlements, medical bill review and negotiation, management of attorney fees and litigation expenses, and identification of subrogation opportunities. Prepare and manage the claims budget, track actual versus projected costs, and provide financial reporting on loss runs, claim reserves, and paid losses. Analyze the financial impact of claims on insurance premiums and work to minimize experience modification rates. Provide training to store management and safety staff on proper incident reporting procedures, claims investigation techniques, and their roles in the claims process. Educate managers on what constitutes a compensable workers' compensation injury, when to report incidents, and how to document events accurately. Serve as the primary point of contact for injured employees, claimants, store management, corporate leadership, and insurance partners. Provide regular status updates to stakeholders, explain claims processes and procedures, and manage 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. Work closely with the Safety team to develop safety programs that prevent injury or accidents, and ensure in-store safety programs are implemented and effective. Assist in the annual insurance renewal process and contribute to budget recommendations. Provide program and administrative support to Director of Risk Management; may represent Director at meetings, etc. May lead projects, as assigned to improve existing programs. Follow all safety policies and procedures. Other duties as assigned. Some of our competitive offerings include generous benefits packages (Health, Dental, Vision, Life and AD&D, 401K), tuition reimbursement and scholarship opportunities, vacation and personal holidays, and in-store purchase discounts. Hiring pay range: $81,386.00 - 98,010.00 Knowledge, Skills and Abilities: 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. Experience: 5 years related experience Education: 4 Year/Bachelors Degree and/or equivalent experience/training in Risk or Safety preferred Other: Up to 30% travel Work Environment: Office, Grocery Store, Other

Created: 2026-03-04