Job Details

ROLE AND ESSENTIAL FUNCTIONS
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.

ESSENTIAL FUNCTIONS

• 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

MINIMUM QUALIFICATIONS

• 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

PREFERRED QUALIFICATIONS

• 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

CORE CAPABILITIES

• 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

RESPONSIBILITIES AS A TEAM MEMBER

• 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