Workers Compensation Department Claims Manager

Job Overview

The Worker's Compensation Claims Manager is responsible for overseeing and managing operations and performance of the organization’s workers' compensation claims program. This role ensures that all claims are handled efficiently, in compliance with relevant laws, and with the aim of minimizing costs while supporting injured members. The Manager will provide leadership, guidance, and oversight to the claims department, collaborate with senior leadership, and ensure the alignment of the workers' compensation program with organizational objectives.

Key Responsibilities

Strategic Oversight and Leadership:

• Lead and manage the entire workers' compensation claims program, ensuring alignment with company goals and objectives.
• Work with upper management to develop and implement strategies to optimize the claims process, reduce claim costs, and enhance program effectiveness.
• Oversee the performance and development of the claims management team, ensuring consistency and quality in claims handling.
• Provide executive-level reporting on claims trends, costs, outcomes, and risk exposure to senior management.

Claims Process Management:

• Ensure the efficient and compliant processing of all workers' compensation claims, from initial reporting to resolution.
• Monitor and evaluate claims for compliance with state and federal regulations, including timely reporting, documentation, and follow-up.
• Oversee the investigation and resolution of complex or high-value claims, coordinating with legal counsel, insurance carriers, and other stakeholders as necessary.
• Direct the handling of disputes, claims denials, and appeals, ensuring that all actions are taken in the best interest of the company and its members.

Risk Management and Cost Control:

• Analyze claims data to identify trends and areas of opportunity for cost reduction and improved claims management.
• Develop and implement proactive risk management strategies, including injury prevention programs, return-to-work initiatives, and early intervention practices.
• Work closely with the Chief Operating Officer and the finance department to establish and manage budgets related to workers' compensation claims and related costs.
• Adhere to claim reporting and reimbursement guidelines established by the WCRA

Compliance and Regulatory Adherence:

• Ensure that all workers' compensation claims are managed in compliance with applicable federal, state, and local regulations, including appropriate claim reporting and additional formwork requirements to MN Dept of Labor & Industry.
• Provide statutorily required claim data – Insurer Assessment reporting - to MN Dept of Labor & Industry.
• Stay informed on changes to workers' compensation laws and industry best practices to ensure that the organization remains compliant.
• Lead audits of the claims process and assist in external audits or regulatory reviews.

Vendor and Insurance Management:

• Oversees relationships with vendor partners such as: legal counsel, preferred medical providers, medical bill review, Pharmacy Benefits Manager, Durable Medical Equipment, etc.
• Negotiate contracts and settlements with external partners to ensure the best possible outcomes for both the company and its employees.
• Evaluate and manage the performance of external service providers, ensuring high-quality and cost-effective claims management.

Team Development and Leadership:

• Provide leadership and mentorship to the workers' compensation claims team, fostering a culture of continuous improvement, accountability, and excellence.
• Develop training programs to enhance team members' skills, knowledge, and performance in claims management.
• Conduct regular performance reviews, provide feedback, and create growth opportunities for staff.

Reporting and Data Analysis:

• Use data insights to develop actionable strategies that improve claims outcomes and reduce operational costs.
• Ensure accurate and timely record-keeping of all claims-related activities and decisions.
• Develop and manage compensation policies and programs that support organizational objectives.

Qualifications

Education:

• Bachelor's degree in Business Administration, Human Resources, Insurance, Risk Management, or a related field.
• Master's degree, juris doctor degree, or equivalent relevant certifications (e.g., Certified Worker's Compensation Professional [CWCP], Associate in Claims [AIC], or similar) preferred.

Experience:

• At least 8-10 years of experience in workers' compensation claims management, with a strong background in leadership and strategic program development.
• Proven experience managing a team, including claims adjusters and supervisors.
• Extensive knowledge of workers' compensation laws, claims management processes, and risk management strategies.
• Experience working with insurance carriers, third-party administrators, and legal professionals to resolve complex claims and mitigate risk.
• Experience in electronic payment processing for Worker's Compensation is a plus.

Skills & Knowledge:

• Strong leadership skills with a proven ability to develop and manage high-performing teams.
• Ability to analyze complex data and provide actionable insights to senior management.
• Strong communication and negotiation skills, with the ability to effectively engage with internal stakeholders, external vendors, and injured employees.
• Proficiency in claims management software, Microsoft Office Suite (Excel, Word, PowerPoint), and reporting tools.

Personal Attributes:

• Excellent organizational and time-management skills with the ability to manage multiple priorities.
• High level of integrity, confidentiality, and professionalism.
• A proactive, results-oriented approach to problem-solving and decision-making.

WHAT WE OFFER

TBG offers a competitive wage based on experience and a variety of benefits, including competitive salary based on experience, health and dental insurance, life insurance, disability, personal time off, paid holidays, vehicle/cell phone/home internet allowance, and a retirement plan with company match.

WHO WE ARE

In 1997, a group of 56 construction companies got together and decided to do something about the out of control costs of workers’ comp insurance. The plan was simple: join together to create a self-insured workers’ comp fund based on the principle... “If responsible people acted responsibly, everyone wins.”

Today, that idea has grown to become the #1 self-insured workers’ comp fund in Minnesota, exclusive to the construction trades. Through TBG, the construction industry has access to affordable, high-quality workers’ comp tailored specifically to their needs. They have a partner who fully understands their risks and is committed to helping them lower costs, create safer workplaces and take better care of their workers.

If being empowered to help our members along their safety journey sounds like an exciting opportunity, apply to join the TBG team today. To learn more, visit www.tbgmn.com.

The Builders Group is an Equal Opportunity Employer.

Job Type: Full-time

Pay: $125,000.00 per year

Benefits:

• 401(k) matching
• Health savings account
• Professional development assistance
• Work from home

Compensation Package:

• Performance bonus
• Profit sharing

Schedule:

• Day shift
• Monday to Friday

Application Question(s):

• What are your salary requirements?

Education:

• Bachelor's (Required)

Experience:

• People Management: 8 years (Required)
• Workers Compensation Claim Management: 8 years (Required)

Work Location: Hybrid remote in Eagan, MN 55121

Salary : $125,000