Workers' Compensation Claims Senior Analyst

Job Description

Job Description

Description:

Acumen Fiscal Agent facilitates freedom, choice, and opportunity through innovative fiscal agent solutions

ROLE AND ESSENTIAL FUNCTIONS

The Workers’ Compensation (WC) Claims Senior Analyst submits and monitors claims for 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.

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 role operates as the hands-on owner of complex claims and the architect of scalable WC processes 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
• ALL Acumen employees will be vigilant to support the positive compliant cybersecurity company posture by familiarizing themselves with all policies, procedures, standards, and guidelines

MINIMUM QUALIFICATIONS

• Bachelor’s degree in a relevant field (Business, Risk Management, Insurance, Finance, Accounting, or related discipline)
• 5 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 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 solve problems 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 to efficiently accomplish mutual goals and assignments
• Requests support from team with ample time to accommodate the support request to meet deadlines
• Ensures effectiveness in processes to achieve/seek best practice

EQUIPMENT NORMALLY USED

• Telephone and headset, computer, multiple screens, copier, scanning system, printer, postage machine, calculator, and fax machines
• May use other office equipment as needed

PHYSICAL AND MENTAL DEMANDS

The demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job, with or without accommodation.

• The employee must be able to sit for extended periods of time entering data into multiple systems
• The employee is regularly required to use their fingers, hands, arms, and eyes to input data and fold and/or cut paper
• The employee is required to answer the phone for the WC claims number as well as respond to team members and internal customers
• The employee is required to operate and maintain a variety of office equipment including a computer, copy machines, scanning and reading equipment and a calculator requiring repetitive motion of the fingers, hands, arms, and eyes
• The employee is frequently required to stand, walk, and talk for an hour or more
• Vision ability is required to do the job, including close vision, color vision and the ability to adjust focus
• Ability to work under stressful conditions that may require handling multiple work assignments with specific deadlines
• Ground and or Air travel upon demand

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 solve problems 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 to efficiently accomplish mutual goals and assignments
• Requests support from team with ample time to accommodate the support request to meet deadlines
• Ensures effectiveness in processes to achieve/seek best practice

EQUIPMENT NORMALLY USED

• Telephone and headset, computer, multiple screens, copier, scanning system, printer, postage machine, calculator, and fax machines
• May use other office equipment as needed

PHYSICAL AND MENTAL DEMANDS

• The demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job, with or without accommodation.
• Must be able to sit for extended periods of time entering data into multiple systems
• Regularly required to use their fingers, hands, arms, and eyes to input data and fold and/or cut paper
• Required to answer the phone for the WC claims number as well as respond to team members and internal customers
• Required to operate and maintain a variety of office equipment including a computer, copy machines, scanning and reading equipment and a calculator requiring repetitive motion of the fingers, hands, arms, and eyes
• Frequently required to stand, walk, and talk for an hour or more
• Vision ability is required to do the job, including close vision, color vision and the ability to adjust focus
• Ability to work under stressful conditions that may require handling multiple work assignments with specific deadlines
• Ground and or Air travel upon demand

ACUMEN IS AN EQUAL OPPORTUNITY EMPLOYER

Acumen is an Equal Employment Opportunity (EEO) employer. We embrace diversity in all its form. We provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information

Note: This job description in no way states or implies that these are the only duties to be performed by the employee in this position. Employees will be required to follow any other job-related instructions and to perform other job-related duties as requested by their supervisor

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