Workers' Compensation Claims Manager

RISE INC FAMILY•Mesa, AZ

3d•$110,000 - $150,000

About The Position

The Workers’ Compensation (WC) Claims Manager leads the strategy, structure, and performance of Acumen’s workers’ compensation program across a multi-state Home and Community-Based Services (HCBS) / Financial Intermediary (FI) environment. This role owns end-to-end claims outcomes and serves as the central authority for claims judgment, financial discipline, and external partner alignment. They serve as the point of alignment for carriers, counsel, and internal partners, ensuring our WC program runs with speed, discipline, and strategic clarity. This position shapes how Acumen manages risk, controls financial exposure, and scales WC operations. The role is deliberately scoped to reflect Acumen’s FI operating model: Acumen is not the employer of record and does not control day-to-day work environments. The role is accountable for claims administration, statutory compliance, financial risk management, and vendor oversight—not workplace safety, injury prevention programs, or worker supervision. This is a senior, judgment-intensive role that operates as both a hands-on owner of complex claims and the architect of scalable WC processes. The Claims Manager shapes how Acumen manages risk, controls financial exposure, and scales WC operations as programs and jurisdictions expand.

Requirements

Bachelor’s degree in a relevant field (Business, Risk Management, Insurance, or related discipline)
8–15 years of progressive workers’ compensation claims experience within a carrier, TPA, or sophisticated in-house environment
Demonstrated ownership of complex, high-severity, and litigated claims
Multi-state workers’ compensation expertise (non-negotiable)
Experience directing and influencing carrier adjusters, defense counsel, and external claims partners
Prior experience supervising, coaching, or mentoring claims professionals or serving as a senior individual contributor with portfolio ownership
Strong strategic judgment across medical, legal, and financial exposure
Comfort making trade-offs and decisions in ambiguous, high-impact situations
Ability to assertively challenge vendors while maintaining productive long-term relationships
Builder mindset with the ability to design processes from scratch and scale them effectively
High attention to detail without losing sight of enterprise-level objectives
Clear, confident written and verbal communication with senior and executive leadership
Ability to manage complexity, move quickly, and adapt across jurisdictions and evolving operational needs

Nice To Haves

Professional designation such as Certified Workers’ Compensation Professional (CWCP) or equivalent demonstrated mastery of WC statutes, claims economics, and loss drivers
Prior experience in healthcare, HCBS, or similarly regulated service environments
Adjuster licensing (current or prior), where applicable

Responsibilities

Own the full workers’ compensation claims lifecycle across all jurisdictions: First Notice of Loss (FNOL) through investigation, treatment, litigation, settlement, and closure
Establish and enforce FNOL standards to ensure timely, complete, and jurisdictionally accurate intake, recognizing FNOL quality as a primary driver of downstream claim cost and defensibility
Personally manage or closely oversee complex, high-severity, high-dollar, or litigated claims, exercising sound judgment on settlement posture and escalation
Set and direct overall claims strategy, including determinations of when to litigate, when to negotiate, and when to settle
Maintain strong financial discipline within Acumen’s workers’ compensation program, including active reserve management, settlement strategy, and claim duration control
Drive faster, cleaner claim resolution through proactive oversight, early decision-making, and disciplined follow-through
Identify systemic drivers of cost and risk, including jurisdictional trends, provider behavior, classification issues, and claim-handling practices
Serve as the primary point of direction and accountability for external partners, including: Third-Party Administrators (TPAs) Insurance carriers Brokers Defense counsel Nurse case management and investigative resources
Direct, influence, and challenge external partners to ensure alignment with Acumen’s strategy, financial objectives, and performance expectations
Establish and maintain a strong operating rhythm, including regular reporting to senior leadership on claim inventory, severity trends, reserve adequacy, litigation exposure, and emerging risks
Translate claims data and experience into actionable insight for Finance and Operations to inform WC pricing, collection rates, and program design
Build WC processes once and scale them consistently across programs and jurisdictions
Partner with Legal and Compliance on audits, disputes, participant inquiries, and regulatory engagement, ensuring decisions reflect statutory obligations and FI role boundaries
Lead and develop internal claims resources or embedded support if and when applicable, setting standards for file quality, documentation, and decision-making
Uphold high standards of documentation accuracy, compliance, and operational discipline across the WC portfolio
Takes personal responsibility for actions. This is demonstrated through owning problems, problem solving and not projecting problems or failures to others or the "system" if not warranted
Demonstrates excellence in work standards, is tenacious in completing tasks
Able to effectively problem solve and make decisions. To include resolving crisis situations and developing resolutions between parties
Works well with other team members and departments
Demonstrates the ability to interact and cooperate using respectful relations in order to efficiently accomplish mutual goals and assignments
Requests support from team with ample time to accommodate the support request in order to meet deadlines
Ensures effectiveness in processes to achieve/seek best practice