Staff Claims Workers Compensation Consultant

Acuity is seeking a Claims Consultant to monitor and ensure consistency in claim handling guidelines, applicable laws, regulatory changes, state reporting, and overall claims practices and philosophy. This role conducts regular audits and communicates findings, supports claims operations through consulting and training, develops training materials, and leads training programs that may include in-field follow‑up visits. This person will act as a liaison between Claims and state agencies. The Claims Consultant also serves as a knowledge resource to other departments, enhancing operations through cross‑functional projects and collaboration while contributing to Acuity’s overall strategic direction.

ESSENTIAL FUNCTIONS:

• Uphold best practices and consistency in claims handling through a variety of audits to ensure uniformity in application of standards, guidelines, and practices; perform individual and special audits as necessary.
• Analyze new and existing insurance laws, bulletins, and regulatory changes, then explain what those rules mean for underwriting or distribution strategy, appetite, product design, and workflows
• Serve as a knowledge resource providing consulting guidance on laws, regulations, industry standards, and claims best practices, including coverage interpretation and claims philosophy, while identifying gaps where current practices may expose the company.
• Create and conduct training programs for both new hires and existing employees, collaborating with claims management on areas of opportunity. Develop training and resource materials, supporting current and emerging topics.
• Partner with management to identify, recommend, and implement changes in company policies, practices, and standards related to diverse claim, product, underwriting, or system requirements, facilitating acceptance and adoption.
• Develop and maintain reference materials supporting best practices.
• Monitor emerging trends and resources through active participation in external organizations and advise on opportunities to incorporate insights into Acuity practices and future business decisions.
• Participate in varied project work, including product innovation, process improvement through system design, as well as vendor and program evaluation, to maximize results.
• Proactively partner with stakeholders and the user community to advance new ideas and assure solutions meet customer needs and expectations.
• Support regulatory examinations, state audits, and data calls by ensuring accurate, consistent reporting and validation of information.
• Research, analyze, and resolve Claims EDI errors to ensure timely and accurate filings
• Reconcile Claims EDI reports and state acknowledgment data to maintain data integrity
• Partner with claims representatives to ensure required data elements are captured for proper Claims EDI filing, including guidance and training where needed
• Display a positive, collaborative, and respectful attitude toward work, co-workers, the company, and others. Uphold Acuity core values and lead by example.
• Always represent Acuity in a professional manner.
• Represent Acuity in a professional manner by upholding Acuity’s Mission, Core Values, and the Business Consulting brand, Partner in Excellence and Innovation.
• Some travel may be required for situations such as training, professional development, and customer contact.
• Regular and predictable attendance.
• Performs other duties as assigned.

EDUCATION:

Bachelor’s Degree or extensive direct experience.

EXPERIENCE:
3-5 years experience in Workers Compensation claims handling or Workers’ Compensation EDI reporting.

OTHER QUALIFICATIONS:

• Demonstrate knowledge of sound claims handling and coverage interpretation.
• Works effectively with stakeholders, customers, and resources from varied disciplines.
• Excel in verbal and written communications, and interpersonal interactions.
• Displays strong capabilities in critical thinking, analysis, and creative design. Willingly pursue innovative approaches and solutions.
• Readily adapts to changing conditions, while remaining positive and productive.
• Effectively prioritizes, organizes, and accomplishes tasks in a self-directed environment.
• Experience with Claims EDI reporting and data exchange processes preferred
• Knowledge of multi-state WC regulations and reporting requirements
• Experience working with Claims EDI vendors and claim system integrations preferred
• Familiarity with IAIABC standards and Claims EDI reporting guidelines preferred
• Experience supporting or participating in system or process improvement initiatives preferred

*Acuity does not sponsor applicants for U.S. work authorization.*

This job is classified as exempt.

The salary range for this position is $90,000 - $125,000 annually. This salary range is an estimate, and the actual salary will vary based on applicant’s education, experience, knowledge, skills, and abilities.

For this role, Acuity offers a comprehensive benefits package, including a generous 401(k) contribution, medical, dental, vision, life and disability insurance, paid time off, an Employee Assistance Program, and more. A full description of benefits and eligibility will be provided to candidates during the hiring process.

We are an Equal Employment Opportunity employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Acuity will include at least one in-person interview during the hiring process for all positions.

If you have a disability and require reasonable accommodations to apply or during the interview process, including for in-person interviews, please contact our Talent Acquisition team at [email protected]. Acuity is dedicated to offering reasonable accommodations during our recruitment process for qualified individuals.