Workers Compensation Claims Manager

Job Description

Job Description

WORKERS' COMPENSATION CLAIMS MANAGER

Internal Risk Management Support | Multi-State Operations

ROLE OVERVIEW

The Workers' Compensation Claims Manager serves as the company's primary point person for managing its workers' compensation claims portfolio across multiple states, with emphasis on California operations. This role bridges internal operations, employee relations, carrier management, and financial oversight—supporting the CFO's responsibility for controlling claims costs, protecting company interests, and ensuring timely, accurate claims administration.

Unlike a carrier-side claims role, this position advocates on behalf of the company, coordinates with injured employees and operations teams, and ensures carriers and TPAs handle claims fairly and efficiently. The manager is the company's representative in all WC matters and helps the CFO make informed decisions about reserves, settlements, and risk management.

KEY RESPONSIBILITIES

• Ensure all workplace injuries are reported to carriers and TPAs within required deadlines.
• Create and maintain a centralized claims tracking system accessible to the CFO showing claim status, cost history, reserve amounts, medical updates, and key dates.
• Consolidate carrier/TPA communications and provide the CFO with regular status updates and cost forecasts.
• Flag claims approaching settlement, reserve adjustments, or litigation to alert CFO.
• Serve as the company's primary contact with carriers and TPAs; represent company interests in all discussions and decisions related to claims.
• Review carrier decisions (denials, reserve increases, medical denials) for reasonableness; escalate concerns to broker and carrier management if decisions appear inappropriate.
• Request and review loss runs, audit reports, and premium reconciliations; flag discrepancies for CFO review.
• Ensure carriers provide timely documentation and updates; escalate delays or unresponsiveness.
• Work with affected employees, site supervisors, and medical providers to develop and execute RTW plans aimed at getting employees back to work safely and quickly.
• Track medical restrictions and accommodate modified duty assignments when feasible.
• Coordinate with HR on leave documentation (FMLA, state leave laws) to avoid conflicts with WC benefits.
• Document RTW efforts and outcomes for the CFO's financial records.
• Coordinate WC claims with ADA accommodation requests and FMLA leave tracking to ensure no conflicts or missed obligations.
• Maintain organized documentation of all accommodations and leave interactions.
• Alert CFO to claims requiring settlement authority or developing litigation plans.
• Participate in settlement discussions to ensure company interests are protected and settlement amounts are reasonable.
• When outside counsel is retained, maintain communication regarding case status, legal strategy, and anticipated costs.
• Provide discovery support (documents, employee statements, medical records) to counsel as requested.
• Provide the CFO with monthly or quarterly claims summaries: number of open claims, total reserves, recent closures, and major cost drivers.
• Track claims trends by location, department, or injury type; identify patterns that might signal safety issues or operational risks.
• Support reserve adequacy assessment and discuss with CFO and broker if reserves appear understated or overstated.
• Share claims data and patterns with the company's safety committee or operations leadership to inform safety priorities.
• Coordinate post-incident investigations to identify root causes and prevention opportunities.
• Provide feedback to CFO and operations on trends that could reduce future claims.
• Maintain secure, organized files for all claims (electronic and hard copy) with clear documentation and audit trails.
• Respond to carrier document requests and discovery requests in a timely manner.
• Manage statute of limitations, appeals deadlines, and other critical dates to avoid missing procedural requirements.

REQUIRED QUALIFICATIONS

• 5+ years of professional experience in a corporate, operations, or administrative role involving workers’ compensation claims.
• Solid understanding of basic workers' compensation principles across multiple states, with particular familiarity with California WC procedures and timelines.
• Proven ability to manage multiple priorities, meet deadlines, and maintain organized systems.
• Strong communication skills; ability to work effectively with injured employees, supervisors, carriers, TPAs, and external counsel.
• Comfort with financial analysis, spreadsheets, and basic cost tracking.
• Discretion and professionalism in handling sensitive employee and medical information.
• Ability to represent company interests professionally but firmly with carriers and external parties.
• Detail-oriented; proactive about identifying issues and bringing them to CFO's attention.

PREFERRED QUALIFICATIONS

• Prior experience in corporate risk management, HR administration, or claims coordination (on the company/policyholder side).
• Direct experience managing workers' compensation claims from an employer's or insurance consumer's perspective.
• Knowledge of California WC law, medical guidelines, and carrier practices.
• Experience with multi-state operations and managing compliance across jurisdictions.
• Familiarity with ADA and FMLA obligations.
• Background in a labor-intensive industry (janitorial, hospitality, staffing, construction, manufacturing).
• General knowledge of insurance coverage and carrier practices

BENEFITS

• Salary: $100,000.00 with bonus potential
• Medical & Dental
• Unlimited PTO
• 401K
• Growth opportunities within a growing hospitality organization