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Job Summary
Job Description
Overview
The Workers’ Compensation Claims Manager manages and provides strategic oversight of the city’s workers’ compensation claims program and return-to-work (RTW) initiatives. This position ensures workers’ compensation claims are managed efficiently, cost-effectively, and in compliance with applicable laws and regulations while supporting injured employees in achieving safe and timely recovery and returning to productive work.
The Manager provides leadership to workers’ compensation coordinators and serves as a key partner to city departments, third-party administrators (TPAs), workers’ compensation medical network providers, nurse case management, and other stakeholders. The role identifies opportunities to reduce claim costs and duration, improve claim outcomes, strengthen RTW practices, and promote a consistent approach to workplace injury management.
Essential Functions
Workers Compensation Claims Management
- Oversee the workers’ compensation claims program from initial injury reporting through resolution and closure.
- Provide leadership, direction, and support to claims staff and coordinators and ensure claims are managed according to established standards and applicable regulations.
- Monitor claim inventories, reserves, payments, medical treatment, indemnity exposure, litigation, and overall claim status.
- Review complex, catastrophic, litigated, and high-exposure claims and establish appropriate action plans.
- Partner with TPAs, defense counsel, medical providers, and other vendors to ensure effective claim management.
- Review and evaluate claim reserves, settlement recommendations, litigation strategies, and financial exposure.
- Monitor claim handling for compliance with applicable workers’ compensation laws, regulations, contractual requirements, and company policies.
- Identify trends in claim frequency, severity, duration, and costs and develop strategies to improve overall program performance.
- Conduct periodic claim reviews with internal stakeholders and external claims administrators.
- Ensure accurate and timely claims reporting, documentation, investigation, communication, and resolution.
Return-to-Work Program Oversight
- Own and provide strategic oversight of the organization’s return-to-work and transitional-duty program.
- Develop, implement, and maintain consistent RTW policies, procedures, guidelines, and best practices.
- Partner with Human Resources, Safety, Occupational Health, managers, supervisors, and medical providers to facilitate safe and timely employee returns to work.
- Establish processes for evaluating temporary work restrictions and identifying appropriate transitional-duty assignments.
- Ensure restrictions and accommodations are appropriately documented, communicated, monitored, and updated.
- Monitor employees on temporary restrictions and ensure work assignments remain consistent with current medical restrictions.
- Establish appropriate escalation procedures for employees who experience challenges returning to work or maintaining modified duty.
- Collaborate with treating physicians and other medical professionals, as appropriate, to obtain clarification of restrictions and functional capabilities.
- Track RTW metrics, including time away from work, modified-duty utilization, lost-time claims, days of disability, and successful return-to-work outcomes.
- Identify barriers to successful RTW and develop solutions in collaboration with business leaders and other stakeholders.
- Educate managers and supervisors regarding RTW procedures, appropriate communication, temporary work assignments, and management of workplace restrictions.
- Promote early intervention and proactive communication following workplace injuries.
- Ensure RTW practices are applied consistently across locations and business units while accounting for applicable legal and operational requirements.
- Evaluate the effectiveness of the RTW program and recommend improvements based on claims data, employee outcomes, and operational feedback.
- Other duties as assigned
Knowledge and Skills
- Demonstrated experience managing or overseeing a return-to-work, transitional-duty, disability management, or absence management program.
- Strong knowledge of Texas workers’ compensation claims practices, regulations, medical management, disability management, and return-to-work principles.
- Experience managing complex, litigated, and high-exposure claims.
- Experience working with TPAs, defense counsel, medical providers, and other claims-related vendors.
- Strong analytical and financial skills, including experience with claims reporting, reserves, loss trends, and program metrics.
- Excellent communication, negotiation, problem-solving, and organizational skills.
- Experience developing or implementing enterprise-wide RTW programs.
- Experience using claims analytics and reporting tools to drive program improvements.
- Ability to influence managers and operational leaders and build effective cross-functional partnerships.
- Proficiency with Microsoft Office and claims management/reporting systems.
Experience
Five (5) years of experience with the Texas Department of Insurance, Division of Workers’ Compensation.
Five (5) years of progressive workers’ compensation claims management experience and self-insured workers’ compensation program experience.
Five (5) years of experience with disability management, occupational health, absence management, or workplace accommodations.
Three (3) years of supervisory/management or program leadership experience.
License(s) and Certification(s)
Valid Driver's License with a good driving record.
Education
Bachelor’s degree in Risk Management, Business Administration, Human Resources, Occupational Health, Insurance, or a related field.
Preference(s)
- Experience working in management in municipal government or large public-sector organizations
- Active Texas All Lines Adjuster License
Equivalency
Master’s degree in Management, Leadership, Business Administration, Public Administration, or a related field may substitute for experience as follows:
Two (2) years of experience with Texas Department of Insurance Division of Workers’ Compensation.
Two (2) years of experience of progressive workers’ compensation claims management experience and self-insured workers’ compensation program.
Two (2) years of experience with disability management, occupational health, absence management, or workplace accommodations.
One (1) year of supervisory or program leadership experience.
Salary Range
$77,272.00 - $96,574.40
The salary listed on this job posting is the starting salary range; amount offered will depend upon qualifications.
City of Dallas is an Equal Opportunity Employer.
