CA - Senior Claims Adjuster, Worker's Compensation

About the role

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make.

Responsibilities

• Independently handle all aspects of the workers’ compensation claims from set-up to closure.
• Evaluate and handle high dollar, high exposure, complex claims.
• Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change.
• Mitigate the complex 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.
• Present claims to senior management, internal and external stakeholders.
• 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.
• Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations.
• Aid 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.
• 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.

Requirements

• High School Diploma or equivalent is required.
• Bachelor's Degree or equivalent experience with some college coursework is preferred.
• Minimum of 5-years workers’ compensation claim adjusting experience is required (carrier background, preferred).
• Claims experience handling California WC claims is required.
• Ability to evaluate and identify high dollar, high exposure, complex claims.
• Requires active licensing in applicable states.
• 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.
• Advanced knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements.
• Advanced knowledge and experience in claim adjudication, medical, and litigation management.
• Advanced ability to analyze and take necessary action in multiple focus areas based on several data points.
• Ability to make claim decisions to mitigate exposure while achieving the best outcome.
• Ability to use skills to overcome conflict and reach beneficial outcomes.
• Ability to mentor junior adjusters.

Qualifications

• High School Diploma or equivalent is required.
• Bachelor's Degree or equivalent experience with some college coursework is preferred.
• Minimum of 5-years workers’ compensation claim adjusting experience is required (carrier background, preferred).
• Claims experience handling California WC claims is required.
• Active licensing in applicable states.
• 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.
• Advanced knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements.
• Advanced knowledge and experience in claim adjudication, medical, and litigation management.
• Advanced ability to analyze and take necessary action in multiple focus areas based on several data points.
• Ability to make claim decisions to mitigate exposure while achieving the best outcome.
• Ability to use skills to overcome conflict and reach beneficial outcomes.
• Ability to mentor junior adjusters.

Skills

• Advanced knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements.
• Advanced knowledge and experience in claim adjudication, medical, and litigation management.
• Advanced ability to analyze and take necessary action in multiple focus areas based on several data points.
• Ability to make claim decisions to mitigate exposure while achieving the best outcome.
• Ability to use skills to overcome conflict and reach beneficial outcomes.
• Ability to mentor junior adjusters.

Benefits

• Competitive cash compensation
• Comprehensive health plans
• Generous PTO
• Futuristic 401k match
• Generous parental and caregiver leave

Pay

Base Compensation Range: $95,000—$120,000 USD

Schedule

The role is remote. Remote team members must live and work in the United States (territories excluded) and have access to reliable, high-speed internet.

Location Information

Unless otherwise specified, this role is remote. Remote team members must live and work in the United States (territories excluded) and have access to reliable, high-speed internet.

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.
• Please click here, here and here for more information.
• Pie Insurance is committed to protecting your personal data. Please review our Privacy Policy.
• Safety First: Pie Insurance is committed to your security during the recruitment process. We will never ask you for credit card information or ask you to purchase any equipment during our interview or onboarding process.

Company Information

• Pie Named to 2025 America's Best Startup Employers
• Pie Insurance 2025 State of Workplace Safety Report