Workers' Compensation & Claims Manager

The Stepping Stones Group, LLC; United States; Remote; USD 90,000 - 120,000; Full time

Job summary

The Stepping Stones Group, LLC is seeking a Workers' Compensation & Claims Manager to independently oversee the full lifecycle of the organization's workers' compensation claims program. You will partner with carriers, TPAs, outside counsel, and internal stakeholders to drive timely, cost-effective claim resolution and safe return-to-work outcomes.

Ideal candidates have 5-7 years of WC claims experience across states, familiarity with ADA and privacy laws, and the ability to work with AI-enabled

Qualifications

• 5-7 years progressive claims/workers' compensation experience.
• Multi-state experience preferred.
• Knowledge of Workers' Comp, ADA, and privacy laws.
• Independent ownership of the full claims lifecycle.
• Experience with subrogation and settlements.

Responsibilities

• Manage workers' compensation claims assigned to carriers or TPAs across states.
• Facilitate resolution by coordinating with employees, management, carriers, and outside counsel.
• Oversee pleadings, discovery, and strategy to control costs and meet service expectations.
• Influence investigations, liability determinations, reserving, settlements, and litigation management.
• Identify and direct subrogation opportunities.
• Participate in settlement mediation meetings.
• Process RTW notices to update employee status and notify managers.
• Ensure timely wage statements and maintain SOPs; update guidelines.
• Report new claims and monitor through resolution; utilize AI tools to optimize processes.

Skills

Workers' compensation

Claims management

Multi-state experience

Return-to-work

Litigation management

Education

Bachelor's degree preferred

Tools

RMIS

Carrier systems

TPA systems

Job description

Under the supervision of the Director of Benefits & Risk Management, the Workers' Compensation & Claims Manager will independently manage the full lifecycle of the organization's workers' compensation claims program, from initial reporting through resolution. This role partners with carriers, third-party administrators (TPAs), outside counsel, and internal stakeholders to drive timely, cost-effective claim resolution, support the insurance procurement and renewal process, and ensure employees return to work safely and promptly.

Outcomes

• Efficiently and professionally reply to workers' comp and claims inquiries within a 24-hour period.
• Help production managers understand the need for a return-to-work program and identify creative ways/roles to return employees to work.
• Follow up with managers once every 5 days when an employee on workers' compensation is cleared to return to work, to confirm they have a position to return to.
• Maintain 90% accuracy and completeness of documentation related to workers' comp and claims requests.
• Work in conjunction with Human Resources Leadership and production managers to get employees back to work in a timely manner.
• Drive favorable claim outcomes by overseeing investigations, liability determinations, reserving, settlement negotiations, and litigation management.

Responsibilities

• Manage workers' compensation claims assigned to insurance carriers or third-party administrators (TPAs); maintain familiarity with applicable laws across multiple states.
• Facilitate the resolution of claims by acting as liaison among employees, management, insurance carriers, outside counsel, and other third-party vendors involved in the claim management process.
• Oversee TPA and outside counsel handling of pleadings, discovery, and strategy, ensuring cost-containment and accountability to service agreements and expectations.
• Positively influence claim handling related to investigations, liability determinations, reserving, benefit payments, vendor utilization, resolution strategies, settlement negotiations, and litigation management.
• Identify and direct subrogation opportunities.
• Participate in claim settlement mediation meetings.
• Process return-to-work (RTW) notices in a timely and accurate manner to ensure employee status is updated and managers are notified.
• Ensure workers' comp wage statements are processed timely.
• Maintain Standard Operating Procedures (SOPs) and Special Claim Handling instructions; verify process documents and materials are accurate and reflect current guidelines, and engage with management to identify gaps in processes and drive solutions.
• Report new workers' compensation claims to the carrier or TPA as needed and monitor claims through resolution.
• Utilize AI technology and other tools to streamline and optimize workers' compensation administrative processes, improving efficiency and accuracy.
• Attend team and department meetings, educational workshops, and trainings as needed; participate in ongoing education that enhances job performance and service quality.
• Other duties and projects as assigned.

Position Location

• Work location: Remote
• Workdays: Monday through Friday
• Work hours: 10:00 AM to 6:00 PM (Eastern Standard Time)

Required Qualifications

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills, and/or abilities required.

• Bachelor's degree (B.A. or B.S.) preferred.
• 5-7 years of progressive claims/workers' compensation experience, including claims investigation, liability/compensability determination, reserving, settlement negotiation, and litigation management, ideally spanning multiple states.
• Practical insurance claim management experience with a carrier, TPA, or corporate risk management department.
• Knowledge of Workers' Comp, ADA, and privacy laws and regulations.
• Comfortable owning the full claims lifecycle independently, from intake through resolution, without dedicated support staff.
• Detail-oriented and skilled in multitasking, prioritizing projects, and meeting deadlines.
• Strong organizational and time management skills.
• Communicates and works well in a team environment; meets established production and quality goals/metrics.
• Follows up in a timely manner on open items.
• Effectively and professionally communicates internally and externally at all levels, including in potentially stressful situations.
• Flexible, adaptable, and successful in a fast-paced environment.
• Ability to work with current technology, including carrier and TPA claim systems, with little instruction.
• Strong critical thinking skills.
• Familiarity with AI-enabled claims, RMIS, or workflow tools used to streamline and optimize workers' compensation administration.

Preferred

• Licensed All-Lines Adjuster in at least one state.
• Experience with high-deductible, self-insured, or self-administered programs.

Reports To

• Director of Benefits & Risk Management

Travel Required

• Travel dependent upon business need but unlikely to exceed 10%.