SR. Workers Comp Claims Specialist

Join our team of more than 34,000 team members, supporting our members and communities in our Club Support Center, 235+ clubs and eight distribution centers. BJ’s Wholesale Club offers a collaborative and inclusive environment where all team members can learn, grow and be their authentic selves. Together, we’re committed to providing outstanding service and convenience to our members, helping them save on the products and services they need for their families and homes.

The Benefits of working at BJ’s

•        BJ’s pays weekly

•Eligible for free BJ's Inner Circle and Supplemental membership(s)*

•        Generous time off programs to support busy lifestyles* 

o Vacation, Personal, Holiday, Sick, Bereavement Leave, Jury Duty

•        Benefit plans for your changing needs*

o Three medical plans**, Health Savings  Account (HSA), two dental plans, vision plan,flexible spending

​•        401(k) plan with company match (must be at least 18 years old)

*eligibility requirements vary by position

**medical plans vary by location

Job Summary:

Execute and implement strategies that will result in reducing claim cost in the workers’ compensation arena. The scope includes: ensuring injured team members receive the best possible care, provides oversight of third party claims administrator (TPA) to achieve optimal financial results; partnering with clubs/DC’s and internal partners to ensure that the workers’ compensation benefits are administered according to State regulations; provide training on workers’ compensation benefits; liaising with all external stakeholders including insurance carriers and outside counsel; accurately setting and monitoring the claim reserves; and proactively monitoring claim best practices and new risk management initiatives to reduce claim severity and costs.

Major Tasks, Responsibilities, and Key Accountabilities:

• Performs claims oversight of a third-party claim administrator (TPA). This includes ensuring TPA best practices are executed; responding to TPA requests for team member information; providing wage information, consults with outside counsel, processes claim billing and funding requests.  
• Partners with TPA to steer claims towards resolution, provides insight to defense counsel and ensures there is an efficient use of BJ’s resources. Reviews open claims to ensure carrier/excess carrier reporting, determines compensability, scheduling of IME’s, medical case management, surveillance, subrogation and litigation tasks are completed timely.  Utilize risk information system to track claims progress.
• Provides direction to ensure the accurately setting monitoring of claim reserves, including written summaries. Approves and suggests amount for reserves and settlements up to authority level.
• Serves as the liaison to Clubs, DC’s, Member care, Benefits to ensure RTW, LOA and general inquiries are answered.  Provide workers’ compensation training to educate clubs/internal partners.
• Manages the data flow through a central Outlook inbox between risk, benefits, HR, LOA, defense counsel and TPA.
• Identifies claim trends and provides recommendations to the Claims Manager and Director, Risk Management, and Insurance for decreasing the frequency of claims.
• Partners with Asset Prevention/Safety on team member claims trend information and any required OSHA reporting.
• Participates in a review of the performance of TPA’s with respect to file reviews, best practice audits, clinical consultation, service providers and claims action plans.
• Participates in department projects and other tasks.
• After hours coverage, including weekends, as needed.

Job Qualifications:

• Bachelor’s Degree preferred
• 3+ years Claim experience required
• Preferred: Insurance industry claim designation
• Ability to multi-task and pivot
• Has in-depth knowledge in own discipline and basic knowledge of related disciplines
• Preferred: knowledge of Texas non-subscriber claims handling 
• Solves complex problems; takes a new perspective on existing solutions
• Oral and written communications skills
• Customer service skills
• Ability to identify and seeks needed information/research skills
• Ability to understand and follow directions
• Ability to use Microsoft 365 tools
• Time sensitive prioritization skills
• Interpersonal skills
• Organization/time management skills
• Insurance, TPA or Retail experience preferred

This is a hybrid role. Tuesday through Thursday are in-office days at BJ's Club Support Center in Marlborough, MA and Monday and Friday are remote days.

In accordance with the Pay Transparency requirements, the following represents a good faith estimate of the compensation range for this position. At BJ’s Wholesale Club, we carefully consider a wide range of non-discriminatory factors when determining salary. Actual salaries will vary depending on factors including but not limited to location, education, experience, and qualifications. The pay range for this position is starting from $75,000.00.