Workers' Compensation Claims Manager

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