Rise Services, Inc. · 10 hours ago
Workers' Compensation Claims Manager
Mesa, AZ
Full-time
Hybrid
Senior Level, Lead/Staff
8+ years expRise Services, Inc. is seeking a Workers’ Compensation Claims Manager to lead the strategy and performance of their workers’ compensation program. This role involves overseeing the entire claims lifecycle, managing complex claims, and ensuring compliance and financial discipline within the program.
Health CareNon Profit
Responsibilities
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
Qualification
Required
Bachelor's degree in a relevant field (Business, Risk Management, Insurance, or related discipline)
8–15 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 supervising, coaching, or mentoring claims professionals or serving as a senior individual contributor with portfolio ownership
Preferred
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
Company
Rise Services, Inc.
RISE provides services for people with disabilities, residential settings, employment, managed care, home & community-based services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Mindi Mitchell, MBA
Chief Operations Officer
Company data provided by crunchbase