ROLE AND ESSENTIAL FUNCTIONS

The Workers Compensation (WC) Claims Manager leads the strategy structure and performance of Acumens workers compensation program across a multi-stateHome 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 Acumens FI operating model:

• Acumen isnot the employer of recordand does not control day-to-day work environments.
• The role is accountable forclaims administration statutory compliance financial risk management and vendor oversightnot 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 Acumens 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 Acumens 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 supportif 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

• Bachelors degree in a relevant field (Business Risk Management Insurance or related discipline)
• 815 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 professionalsorserving as a senior individual contributor with portfolio ownership

PREFERRED QUALIFICATIONS

• Professional designation such asCertified 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