2025 Theo Award Winner: Wells Fargo

Wells Fargo faced a common industry challenge with its workers’ compensation program: How to make quarterly audits something adjusters could embrace. The company wanted employees to view it as an opportunity for growth and improvement while also enhancing the partnership.

Tackling the Problem

Wells Fargo took decisive action to revamp its quarterly audit program, transforming it from an evaluation into a productive coaching opportunity. The company shifted the focus from identifying mistakes to recognizing achievements and providing mentorship.

Brent Mortensen, executive director of corporate insurance claims at Wells Fargo, explained the philosophical change.

“It’s all about shifting the mindset from finding what is being done incorrectly to rewarding and mentoring what’s being done correctly,” he said.

Each quarter, Wells Fargo reviews six months of each claims adjuster’s work and hosts calls to offer constructive feedback and growth opportunities.

The company emphasized transparency and timeliness in these evaluations, providing near real-time feedback. Adjusters receive encouragement to ask questions about categories where they scored low, supporting continuous improvement. Wells Fargo explains why certain standards matter and invites team members to share perspectives, fostering shared ownership.

Wells Fargo enhanced its annual workers’ compensation summit to strengthen relationships between internal teams and third-party administrator partners. The two-day summit includes informative sessions on empathy training, medical management, claims management techniques, and customer service training. This comprehensive approach addresses the essential skills needed in workers’ compensation management.

The company also made a strategic decision to add a full-time nurse case manager to the account.

“We advocated for a dedicated nurse on our account, and it’s been a game changer,” Mortensen said.

This investment ensures adjusters don’t hesitate to include clinical support due to cost concerns. The dedicated nurse provides medical insights and guidance while supporting claim strategies from the outset.

Wells Fargo recognized that factors beyond workplace injuries could affect claim outcomes and closure rates. The company incorporated behavioral health specialists on many claims to assist injured workers with issues unrelated to their specific claims, acknowledging that external factors influence recovery and return-to-work success.

The company built strong collaborative relationships with its third-party administrator, Sedgwick, and broker partner, Marsh. Wells Fargo maintains regular communication with workers’ compensation adjusters and account management teams, working together to resolve issues and support claim strategies. This partnership approach creates an environment where adjusters feel supported and empowered.

Organization: Wells Fargo * Location: San Francisco * Number of Employees: 217,000 * Category: At Large

“We’ve built a great partnership with our TPA, Sedgwick,” Mortensen said. “We maintain good relationships with our workers’ compensation adjusters and account management, working together to resolve issues and support claim strategies.”

Success to Build On

Wells Fargo’s comprehensive approach yielded impressive improvements across multiple performance metrics. The company observed significant increases in three-point contact and investigation scores, rising from the low 80% range to the mid-90% range in many categories.

Specific improvements demonstrated the program’s effectiveness. Initial investigation scores for medical-only claims jumped in 2024 and again in 2025. Injury and disability management scores for the same category improved dramatically. Three-point contact scores for indemnity claims rose, while claim management scores saw a healthy increase as well.

These improvements translate into meaningful benefits for injured workers and the company. “We emphasize empathy and a positive claim experience – making timely contact shows our injured workers we care and ensures they get the support they need,” Mortensen said. The enhanced investigations provide better understanding of the care workers may need, leading to more timely claim decisions, faster medical care, and clearer communication.

The transformation created a positive cycle of engagement and retention. Examiners visiting Wells Fargo’s site for the annual summit express eagerness to work on the account. The company experiences typically low turnover among assigned examiners, with most changes resulting from promotions rather than departures.

Wells Fargo’s investment in a dedicated nurse case manager impacted medical spending while providing stronger support and care for employees. The early engagement of clinical expertise in claims management led to lower overall costs and better outcomes for injured workers.

The company’s approach to building relationships extends beyond traditional boundaries. Wells Fargo treats adjusters as valued team members by investing in compensation that rewards high performance and builds mutual loyalty. The company focuses on creating an account that professionals want to join and remain with long-term.

Brent Mortensen, executive director of corporate insurance claims, Wells Fargo

“We first say, ‘Be an account that everyone wants to be on,’ ” Mortensen said. “Build a reputation for valuing your team by recognizing great work and investing in onboarding new adjusters so they can start strong.”

Wells Fargo’s success demonstrates the power of collaboration between internal teams and external partners. The company’s dedicated internal team champions their partners, helping them consistently outperform peer groups across nearly every category. This collaborative approach includes discussing obstacles, exploring solutions, and including clinical expertise to provide comprehensive support.

The program’s success reflects Wells Fargo’s broader commitment to employee care and safety. By focusing on early intervention, clear communication, and comprehensive support, the company created an environment where injured workers receive the care they need while managing costs effectively.

Wells Fargo’s transformation of its workers’ compensation program illustrates how shifting to a supportive approach can yield significant benefits. The company’s focus on coaching, collaboration, and comprehensive care created measurable improvements in performance metrics while fostering an environment of mutual respect and shared success.

“We lead with empathy, offer grace when appropriate, emphasize accountability, and celebrate success together,” Mortensen said, encapsulating Wells Fargo’s philosophy of balancing compassion with responsibility in caring for its employees. &

The Theo Award celebrates its sophomore year, honoring 32 workers’ compensation programs for their excellence and service to workers across the nation. To learn more about the award and amazing qualities each winner possesses, visit here.

New Jersey WCMCO vs MCO

The importance of care direction and the provider network.

Workers’ compensation is designed to provide medical care and wage replacement to employees who suffer job related injuries or illnesses. In New Jersey, workers’ compensation is regulated by the Division of Workers’ Compensation under the Department of Labor and Workforce development.

A critical component of a successful workers’ compensation system lies in how medical care is delivered and managed. This is where the distinction between a Workers’ Compensation Managed Care Organization (WCMCO) and a traditional Managed Care Organization (MCO) becomes especially important. Horizon Casualty Services (HCS) is an affiliate of Horizon Blue Cross Blue Shield of New Jersey; however, the product that HCS delivers to its clients – a robust occupational health network – is different than the medical products that Horizon Blue Cross Blue Shield of New Jersey delivers to its members.

A WCMCO is specifically designed to address the unique needs of the workers’ compensation system. A traditional MCO operates in the group insurance space focusing on providing access to routine and preventive care and managing complex health care needs in the right setting, while a WCMCO is structured around the effective and appropriate management of occupational injuries. A WCMCO focuses on timely treatment, appropriate return to work strategies, and regulatory compliance within the workers’ compensation framework. While both types of organizations manage provider networks and oversee care delivery, a WCMCO must adhere to different standards and legal obligations specific to workplace injuries. A WCMCO must focus solely on the claimant’s injury and not take into consideration the claimant’s other health conditions.

Provider networks play a pivotal role in the effectiveness of the overall workers’ compensation process. These networks are composed of physicians and specialists experienced in occupational medicine and trained in the documentation and protocols necessary for managing work related injuries. HCS partners with providers on education, a critical component to maintaining its prominent status in New Jersey. Using specialized oversight strategies also ensures providers meet performance benchmarks. This includes regular quality audits, outcome tracking, adherence to evidence-based guidelines such as ODG, and prompt communication with all parties involved in the claim.

WCMCOs focus on return-to-work outcomes, or the complexities of workers’ compensation claims management. The HCS provider network has been cultivated over the last 30 years to streamline and identify the best occupational health providers in New Jersey. HCS established and maintains its own Outcomes Focused Network (OFN) which ensures claimants will receive optimal care.

Heidi Coluni, Director of Provider Network Services, HCS

Heidi Coluni, Director of Provider Network Services, HCS, added “When I joined the organization almost 5 years ago, I did not realize how different a WCMCO operates from an MCO and the utmost importance of having the right provider in place the very first time an injured worker is seen. The OFN that my team has built over the years under Maura Berger, RN, ensures that our clients have access to not only providers, but access to providers who understand the difference between an injured worker and an insurance member.”

“I quickly learned that it’s nearly impossible to treat an injured worker like a member, so I dropped my MCO mindset,” Coluni added.

One of the most important advantages of having the right provider network in place is the ability to direct care from the outset of a claim. In New Jersey, employers have the right to choose the treating physician for workers’ compensation claims. This means that if a robust and high-performing provider network is already established, the employer or insurance carrier can quickly direct the injured worker to a highly qualified, in-network physician who specializes in occupational injuries. The early intervention is critical for several reasons:

1) Getting the injured worker to the right doctor early improves diagnostic accuracy and treatment outcomes. A provider familiar with work-related injuries will not only treat the condition effectively but will also be equipped to assess work restrictions and recovery timelines.

2) Early and appropriate care can reduce the likelihood of complications or delayed recovery, which in turn lowers the cost of the claim.

3) Timely and transparent communication from the provider helps claims adjusters make informed decisions quickly, preventing administrative delays and ensuring that benefits are delivered without unnecessary interruptions. Collaborating with providers ensures that notes are delivered promptly, and causality statements are clear right from the start.

Moreover, the direction of care at the beginning of the claim helps establish a framework for consistent, goal-oriented treatment. With the right providers in place, treatment plans are more likely to align with return-to-work goals and avoid unnecessary procedures or referrals. This coordination promotes accountability between workers, employers, and insurers.

The structure and oversight of medical provider networks are essential components of the workers’ compensation system in New Jersey. By leveraging the strengths of a well-managed provider network, employers and insurers can ensure that injured workers receive prompt, effective care from the right specialists. This early direction of care not only enhances recovery outcomes for the injured workers but also contributes to the overall success and efficiency of the workers’ compensation claim process. HCS is well poised to offer its workers’ compensation clients and prospective clients a network of professionals focused on occupational health throughout New Jersey.

For More Information

To learn more, email Jed Hoban, HCS Business Development Executive, at [email protected] or visit or visit https://www.horizonblue.com/horizoncasualty/.

About Horizon Casualty Services, Inc.

HCS, in business since 1994, is a leading PPO in New Jersey WC and PIP. HCS has a 100% direct-contracted provider network that includes almost all New Jersey acute care hospitals. The network delivers significant overall savings and, with its deep focus on precision, an extremely low appeals rate. Its PPO results, combined with its Healthcare Value Strategy and Outcomes Focused Network, enable insurers to be the best at delivering quality medical care to claimants at the right cost — clearly a win-win for all. HCS and Horizon Blue Cross Blue Shield of New Jersey are independent licensees of the Blue Cross and Blue Shield Association.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Horizon Casualty Services, Inc. The editorial staff of Risk & Insurance had no role in its preparation.

Horizon Casualty Services Inc., an affiliate of Horizon Blue Cross Blue Shield of New Jersey, in business since 1994, is a leading PPO in New Jersey workers' compensation and personal injury protection. The company's 100% direct-contracted provider network includes almost all New Jersey acute care hospitals, significant overall WC savings and, with its deep focus on precision, an extremely low WC appeals rate of 0.2%. Its PPO results, combined with its WC healthcare value and OFN strategy, enables insurers to be the best at delivering quality medical care to claimants at the right cost — clearly a win-win for all.

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