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Employee Benefits Account Manager (Growth & Gaps Team)
Higginbotham
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Active Life & Health License required
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Administrative Assistant II
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Closed listing

JOB OPTIONS INC

Workers Compensation Manager

San Diego, CA, United States

$85,000 to $95,000 USD / year

This opening has closed.

The original listing is kept below for reference.

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Job details

Pay: $85,000 to $95,000 USD / year
Posting language: English

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Original job description

Archived listing. The details below describe a past opening.

SUMMARY: The Workers’ Compensation Manager leads the Company’s workers’ compensation program, with primary responsibility for the strategic oversight of complex, high-exposure, and litigated claims. This position partners with insurance carriers, third-party administrators (TPAs), defense counsel, medical providers, Human Resources, and Operations to advance timely and appropriate claim resolution, manage financial exposure, support injured employees, and strengthen return-to-work and loss-prevention practices. The Manager independently monitors claim activity and recommends litigation, reserve, settlement, and closure strategies while respecting the authority of the claim's administrator, counsel, and other authorized decision makers.

Requirements

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Own day-to-day oversight of the workers’ compensation claims portfolio, including complex, disputed, catastrophic, cumulative-trauma, and litigated claims; maintain accurate records, diaries, and action plans.
Serve as the Company’s primary liaison with claims adjusters, TPAs, insurance carriers, defense counsel, applicant attorneys as appropriate, medical providers, and internal stakeholders.
Conduct regular litigated-claim reviews with defense counsel and adjusters; assess case posture, liability and exposure, discovery needs, medical evidence, anticipated milestones, and next steps.
Monitor WCAB proceedings and litigation milestones, including applications, hearings, depositions, subpoenas, medical-legal evaluations, and trial preparation; coordinate employer records and witness participation with counsel.
Evaluate defense strategy, settlement opportunities, and claim-closure plans; make documented recommendations regarding Compromise and Release, Stipulations with Request for Award, and other appropriate resolutions, subject to required approvals.
Review claim reserves, incurred and paid losses, allocated legal expenses, and settlement projections; challenge unsupported assumptions and recommend timely reserve adjustments to the responsible claims administrator.
Identify potential defenses, apportionment, subrogation, contribution, fraud indicators, and compensability concerns; refer matters for appropriate investigation or legal evaluation without independently making determinations reserved to authorized parties.
Oversee timely injury reporting, claim intake, documentation, investigation coordination, and follow-up; ensure accurate and confidential recordkeeping in UKG Ready and other authorized systems.
Coordinate medical status tracking, work restrictions, modified-duty opportunities, return-to-work plans, and the interactive accommodation process in partnership with HR and Operations.
Monitor temporary and permanent disability exposure, medical treatment disputes, utilization review and independent medical review developments, and medical-legal processes in coordination with the administrator and counsel.
Review TPA and defense counsel performance, including responsiveness, file documentation, litigation plans, and legal spend, reserve accuracy, and progress toward resolution; escalate concerns.
Prepare periodic dashboards and executive reports on open claims, litigated inventory, aging, frequency, severity, total incurred costs, reserves, legal expense, closure rates, and return-to-work results.
Identify loss trends and recommend prevention measures, supervisor training, incident-investigation improvements, and operational controls in partnership with Safety and Operations.
Provide practical guidance to employees, supervisors, and managers on reporting injuries, workers’ compensation procedures, documentation, and appropriate communication.
Coordinate with Payroll, Benefits, Finance, and HR regarding wage information, leave coordination, benefit offsets, and financial reporting as appropriate.
Maintain working knowledge of applicable California workers’ compensation requirements and relevant laws in other states where the Company operates; collaborate with counsel on compliance matters.
Protect confidential medical, personnel, and litigation information; follow applicable privacy, records-retention, and access-control requirements.
Perform other related duties as assigned.

SUPERVISORY RESPONSIBILITIES: This position manages the workers’ compensation program and directs work through cross-functional partnerships and external service providers. This position does not routinely supervise employees but exercises significant independent judgment and regularly coordinates activities among internal stakeholders, claims administrators, legal counsel, and external service providers.

QUALIFICATIONS: Demonstrated ability to independently manage a substantial portfolio of complex and litigated workers’ compensation claims, exercise sound judgment, communicate with counsel and executives, and influence outcomes without exceeding delegated authority. Strong analytical, negotiation, organizational, documentation, and relationship-management skills are required. Exercises independent judgment and discretion regarding claim strategy, risk assessment, reserve analysis, return-to-work programs, and recommendations affecting Company financial and operational interests.

EDUCATION and/or EXPERIENCE:

Minimum seven (7) years of progressively responsible workers’ compensation claims management or administration experience, including at least five (5) years of substantial, hands-on experience with California litigated claims.
Demonstrated experience participating in litigation strategy reviews, evaluating medical-legal evidence, analyzing reserves and settlements, and coordinating with defense counsel and claims administrators.
Experience with employer-side claims oversight, self-insured programs, insurance carriers, or TPAs; experience managing high-volume, multi-site workforces strongly preferred.
Bachelor’s degree in Human Resources, Risk Management, Business Administration, or a related field preferred; equivalent relevant experience considered.
Advanced knowledge of California workers’ compensation processes, WCAB practice, disability benefits, apportionment, settlement structures, return-to-work practices, and claim financial analysis.
Proficiency with spreadsheets, claims reporting, HRIS systems (including UKG Ready or similar), and executive-level reporting.

CAREER PATH: Potential progression to Senior Manager, Workers' Compensation, Director of Risk Management; or other leadership roles based on organizational needs, qualifications, and demonstrated performance.

INTERNAL AND EXTERNAL BUSINESS CONTRACTS: Executive Leadership, Human Resources, Payroll, Finance, Operations, Safety, insurance carriers, TPAs, defense counsel, medical providers, investigators, and other authorized partners.

CERTIFICATES, LICENSES, REGISTRATIONS: Relevant professional credentials (such as Workers’ Compensation Claims Associate (WCCA), Workers’ Compensation Claims Professional (WCCP), Associate in Risk Management (ARM), or similar), preferred but not required. Any license required for duties actually assigned must be maintained.

BACKGROUND INVESTIGATION: Any background screening requirements will be administered in accordance with applicable federal, state, and local law, including California Fair Chance Act requirements. This includes a company-conducted background check, as well as any required national or state criminal background checks or fingerprinting, and verification of legal authorization to work in the United States.

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Jobs in the United States