Acumen Fiscal Agent

Workers' Compensation Claims Manager

Acumen Fiscal Agent

full-time

Posted on:

Location Type: Hybrid

Location: Mesa • Arizona • United States

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Job Level

SeniorLead

About the role

  • 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

Requirements

  • __**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
Benefits
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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
workers' compensation claims managementclaims lifecycle managementreserve managementsettlement strategyclaims data analysisprocess designmulti-state workers' compensation expertiselitigated claims managementfinancial disciplinerisk management
Soft Skills
strategic judgmentdecision-makingrelationship managementcoachingmentoringcommunicationattention to detailadaptabilityproblem-solvingleadership
Certifications
Bachelor's degreeCertified Workers' Compensation Professional (CWCP)Adjuster licensing