Injury Management Claim Director Purpose and DescriptionThe Injury Management Claim Director provides strategic leadership, operational oversight, and technical expertise for all workers' compensation, Police and Fire IOD and other similar types of claims. This position is responsible for the management of claim operations, supervision of claims professionals and vendors, oversight of complex and high-exposure claims, regulatory compliance, financial stewardship, and development of claim management strategies that support organizational goals while ensuring high-quality outcomes for injured employees and insured members.
The Claim Director collaborates with executive leadership, risk management, underwriting, legal counsel, medical management professionals, and external service providers to drive claim resolution, control costs, improve return-to-work outcomes, and maintain regulatory compliance.
Essential Duties and ResponsibilitiesLeadership and Management- Direct and manage the day-to-day operations of the Injury Management claims department.
- Supervise, mentor, and develop supervisors, claim representatives, nurse case managers, and support staff.
- Establish performance standards, workflows, and quality assurance programs.
- Conduct regular file reviews and operational audits.
- Promote a culture of service excellence, accountability, and continuous improvement.
Claims Oversight- Provide technical guidance and authority on complex, catastrophic, litigated, and high-exposure claims.
- Monitor claim investigations, compensability determinations, reserving practices, and settlement strategies.
- Review and approve reserve recommendations and settlement authority requests within assigned authority levels.
- Ensure timely and appropriate claim handling consistent with statutory requirements and industry best practices.
- Oversee management of medical-only, lost-time, and catastrophic injury claims.
Regulatory Compliance- Ensure compliance with all applicable workers' compensation statutes, regulations, reporting requirements, and internal policies.
- Monitor legislative and regulatory developments impacting workers' compensation programs.
- Coordinate audits and regulatory examinations.
- Maintain appropriate documentation, reporting, and record retention protocols.
Minimum RequirementsThe following are required to enable the employee to perform the essential functions of the job.
- Skills/knowledge - Above average written and verbal communication skills with the ability to effectively motivate and lead staff. Sound interpersonal skills are essential. Must be able to conduct training on technical matters.
- Experience/education - Ten years of workers' compensation claims experience including 3-5 years of management or supervisory experience. College degree or comparable work experience required. Professional designation and achievement of related insurance industry or management courses desired.
