Senior Claims Adjuster, Workers Compensation

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.

About the role

The Senior Claims Adjuster will play a critical role in delivering quality claim file management and an industry-leading customer claims experience by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best-in-class performance, identify and pursue claim mitigation opportunities, and deliver favorable claim outcomes for Pie’s customers.

Responsibilities

• Independently handle all aspects of 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 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 case facts and company best practices.
• Present claims to senior management, internal and external stakeholders.
• Administer statutory medical and indemnity benefits timely 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 partner agents and customers to provide general claim guidance and set claim process expectations.
• Assist in providing claim status to agents and insureds, coverage verification, and loss run reports.
• Provide excellent customer service to internal and external customers and business partners.
• Advocate to ensure Pie has a leading claims customer experience.
• Work to continuously improve claims operations and identify opportunities and gaps in claim service, handling SOPs, protocols, and processes.
• Mentor junior adjusters.

Requirements

• High School Diploma or equivalent is required.
• Bachelor’s Degree or equivalent experience with some college coursework is preferred.
• Minimum of 5 years of workers’ compensation claim adjusting experience (carrier background preferred).
• Preferred claims experience in 3 or more of the following jurisdictions: FL, GA, NC, SC, TN, AL (with emphasis on NC, TN, AL).
• Active licensing in applicable states.
• Advanced knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements.
• Advanced knowledge and experience in claim adjudication, medical, and litigation management.
• Ability to evaluate and identify high-dollar, high-exposure, complex claims.
• Strong communication (written and verbal) skills to deliver complex information effectively.
• Strong problem-solving skills to manage complex tasks and work through solutions with minimal guidance.
• Awareness of your own tasks and how they impact the team and deliverables.
• Experience using G-Suite Tools and collaboration tools like Slack is preferred.
• 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.

Pay

Base Compensation Range: $85,000—$110,000 USD

Benefits

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

Schedule

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.