Workers Compensation Claims Manager

Tristar Insurance•Irving, TX

3d•$105,000 - $125,000•Onsite

About The Position

Under minimal supervision and reporting to the Area Manager, the Claims Manager manages and directs the operations of the workers’ compensation claims unit. This position oversees Claims Supervisors, Claims Examiners, and Claims Assistants to ensure high-quality claims handling, effective client service, and compliance with applicable state laws, company policies, Best Practices, and client-specific handling instructions. The Claims Manager provides operational leadership, technical guidance, and staff development while overseeing staffing, claims quality, financial controls, and client relationships.

Requirements

High school diploma or GED required.
Five (5) to ten (10) years of related experience, or an equivalent combination of education and experience.
Strong technical knowledge of workers’ compensation claims handling, applicable statutory and regulatory requirements, and medical terminology.
Ability to manage diary systems, prioritize competing responsibilities, and meet strict deadlines.
Strong analytical skills and sound judgment when reviewing complex claims and operational matters.
Proficiency in Microsoft Word and Excel.
Excellent written and verbal communication skills, including the ability to clearly convey technical information to claimants, clients, management, and staff.
Ability to supervise and develop employees with varying experience and skill levels.
Strong leadership and interpersonal skills.
Excellent customer service skills and the ability to resolve escalated concerns professionally.
Ability to monitor workloads, coordinate staffing, and maintain consistent quality and service standards.

Nice To Haves

Bachelor’s degree in a related field preferred.

Responsibilities

Supervises assigned Claims Supervisors, Claims Examiners, and Claims Assistants, including monitoring attendance, evaluating performance, providing coaching, and addressing disciplinary matters in partnership with Human Resources.
Oversee claims-handling activities, including initial and periodic reviews, delays, denials, and other time-sensitive claim decisions.
Review and approve reserve changes, awards, and payments within delegated authority levels, obtaining additional authority when required.
Conduct claim-file reviews to evaluate quality, documentation, reserve adequacy, and compliance with applicable laws, company procedures, and client requirements.
Coordinate and lead staff training on changes to applicable laws, policies, procedures, and claims-handling practices.
Coordinate, conduct, and document internal and external educational sessions.
Monitor claim inventories, workloads, and staffing levels to ensure daily operational and client-service requirements are met.
Oversee and approve daily check runs and payment registers in accordance with established financial controls.
Respond to escalated claimant and vendor concerns and coordinate appropriate resolution.
Monitor vendor performance, service quality, and effectiveness.
Ensure adherence to client service instructions and Customized Handling Instructions.
Coordinate and provide claims-handling coverage during examiner absences and position vacancies.
Prepare, review, and evaluate monthly client reports for accuracy, completeness, and timely delivery.
Facilitate internal and external audits and oversee any required corrective actions.
Partner with the corporate office and sales/service team on requests for proposals (RFPs) and service-related matters.
Attend client file reviews and address claims-handling questions, concerns, and recommendations.
Provide account management for accounts without an assigned Account Manager.
Monitor branch expenses and review and approve invoices within delegated authority levels.
Perform other duties as assigned.