CA and AZ - Claims Adjuster, Workers Compensation

Claims Technical Management

Independently handle all aspects of the workers’ compensation claims from set-up to closure.

Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change.

Mitigate claim exposure while achieving the best outcome.

Determine timely and accurate compensability decisions within statutory requirements.

Set and adjust timely/accurate reserves within authority limits to ensure reserving activities are consistent with the case facts and company best practices.

Timely administration of statutory medical and indemnity benefits throughout the life of the claim.

Comply with all applicable statutory guidelines, rules, and regulations.

Control legal activity with defense counsel through the litigation process while managing legal fees and costs.

Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement.

Claims Customer Service

Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations.

Aid as necessary in providing claim status to agents and insureds, coverage verification and loss run reports, etc.

Provide excellent customer service to internal and external customers and business partners.

Participate in interactions with TPA adjusters and claims partners to drive optimized claims outcomes and top-notch claims experience.

Advocate to ensure that Pie has a leading claims customer experience.

Work to continuously improve our claims operations and look at opportunities and gaps in claim service, handling SOPs, protocols and processes.

The Right Stuff

• High School Diploma or equivalent is required.
• Bachelor's Degree or equivalent experience with some college coursework is preferred.
• Minimum of 2-years workers’ compensation claims experience is required.
• Claims experience working in CA and AZ is required.
• Strong communication (written and verbal) skills, to deliver more complex information effectively.
• Strong problem solving skills to be able to manage complex tasks and work through to solutions with little guidance and direction.
• Awareness of your own tasks, and how it impacts the team and deliverables.
• Experience using G-Suite Tools, and collaboration tools like Slack is preferred.
• Knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements.
• Demonstrated knowledge and experience in claim adjudication, medical management and litigation management.
• Developing ability to analyze and take necessary action in multiple focus areas, based on several data points.
• Ability to use skills to overcome conflict and reach beneficial outcomes.
• Ability to make claim decisions to mitigate exposure while achieving the best outcome.

Compensation & Benefits

Competitive cash compensation

Comprehensive health plans

Generous PTO

Future-focused 401k match

Generous parental and caregiver leave

Core Values

Making every part of working with us "Easy as Pie" - including our offer process.

Additional Information

Pie Insurance is an equal opportunity employer.

We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic.

Pie Insurance participates in the E-Verify program.

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