5-10 years of workers' compensation claims experience or equivalent education and experience.
Proven experience in supervising and developing claims professionals.
Strong technical knowledge of claims handling and regulatory requirements.
Experience in overseeing claims operations and evaluating claims quality.
Excellent analytical and problem-solving skills.
Effective leadership and communication skills.
Responsibilities
Manage daily operations of the workers' compensation claims unit.
Provide leadership and professional development for staff.
Oversee claims-handling activities and time-sensitive decisions.
Review and approve reserve changes and payments.
Conduct claim-file reviews for quality and compliance.
Monitor claims inventories and staffing levels for efficiency.
Address escalated concerns and facilitate resolutions.
Benefits
Professional development opportunities.
Collaborative work environment.
Supportive leadership team.
Access to industry best practices and training.
Potential for career advancement.
Full Job Description
Workers' Compensation Claims Manager
Location: West Dallas, TX Employment Type: Full-Time Position Level: Management
Position Overview
We are recruiting for an experienced Workers' Compensation Claims Manager to oversee the daily operations of a workers' compensation claims unit for an established organization within the claims administration industry.
This position is responsible for leading Claims Supervisors, Claims Examiners, and Claims Assistants, ensuring high-quality claims handling, regulatory compliance, operational efficiency, and strong client service.
The ideal candidate will bring a strong background in workers' compensation claims administration, demonstrated leadership capabilities, and the ability to manage claims operations, develop staff, and maintain effective client relationships.
Key Responsibilities
Manage and oversee the daily operations of a workers' compensation claims unit, including Claims Supervisors, Claims Examiners, and Claims Assistants.
Provide leadership, coaching, performance evaluations, and ongoing professional development for assigned staff.
Oversee claims-handling activities, including initial and periodic reviews, delays, denials, and other time-sensitive claim decisions.
Review and approve reserve changes, awards, and payments within established authority levels.
Conduct claim-file reviews to evaluate claims quality, documentation, reserve adequacy, and compliance with applicable laws and client requirements.
Monitor claims inventories, workloads, and staffing levels to maintain operational efficiency and service standards.
Coordinate staff training on regulatory changes, claims-handling procedures, and industry best practices.
Oversee financial controls, including payment approvals, check runs, and expense management.
Address escalated claimant, client, and vendor concerns and facilitate timely resolution.
Monitor vendor performance and service quality.
Ensure compliance with client-specific claims-handling instructions and service expectations.
Coordinate claims-handling coverage during staffing vacancies or employee absences.
Prepare and review monthly client reports for accuracy, completeness, and timely delivery.
Facilitate internal and external claims audits and oversee corrective actions when necessary.
Participate in client file reviews and address claims-handling questions and recommendations.
Support client account management activities and collaborate with internal teams on service-related matters and requests for proposals.
Monitor operational expenses and approve invoices within established authority levels.
Required Qualifications
Active Texas Adjuster License required.
5-10 years of related workers' compensation claims experience, or an equivalent combination of education and experience.
Demonstrated experience supervising, coaching, and developing workers' compensation claims professionals.
Strong technical knowledge of workers' compensation claims handling, applicable statutory and regulatory requirements, and medical terminology.
Experience overseeing claims operations, reviewing complex claims, and evaluating reserve adequacy and claims quality.
Ability to manage claims diary systems, prioritize competing responsibilities, and meet established deadlines.
Strong analytical, problem-solving, and decision-making skills.
Effective leadership and interpersonal skills, with the ability to manage employees across varying experience levels.
Excellent written and verbal communication skills, including the ability to communicate technical claims information to clients, management, and staff.
Strong client service skills and the ability to professionally resolve escalated concerns.
Ability to monitor workloads, coordinate staffing needs, and maintain consistent claims quality and service standards.
