Claims Adjuster, Worker's Compensation

Pie Insurance; United States; Remote; USD 70,000 - 90,000; Full time

Benefits offered by this job

Competitive cash compensation

Generous PTO

Future focused 401k match

Generous parental and caregiver leave

Our core values are reflected in work

Job summary

Pie Insurance is seeking a Claims Adjuster to manage workers’ compensation claims from setup to closure, with emphasis on timely investigations, reserving, benefits administration, and favorable outcomes for policyholders.

The role emphasizes customer-focused service, collaboration with agents, TPAs, and internal partners, and compliance with regulatory requirements. Remote within the United States; base pay ranges from $70,000 to $90,000 per year.

Qualifications

• Requires high school diploma; bachelor’s degree preferred.
• Minimum 2 years of workers’ compensation claims experience.
• Strong communication and problem-solving skills essential.

Responsibilities

• Handle all aspects of workers’ compensation claims from start to closure.
• Conduct timely 3-point contact investigations as facts evolve.
• Mitigate exposure while aiming for favorable outcomes.
• Determine timely compensability within statutory requirements.
• Set and adjust reserves within authority limits.
• Administer statutory medical and indemnity benefits throughout the claim life cycle.
• Comply with statutory guidelines and regulations.
• Manage defense counsel and litigation costs.
• Pursue early resolution opportunities and negotiate settlements.

Skills

Strong communication

Problem solving

Regulatory knowledge

CMS/MSA knowledge

Data analysis

G-Suite tools

Slack

Independent worker

Education

High School Diploma or equivalent

Bachelor’s degree preferred

Tools

G-Suite

Slack

Job description

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.

The Claims Adjuster will play a vital role in delivering quality claim file management and an industry-leading customer claims experience. This will be completed 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.

How You’ll Do It

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.
• Assist 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 the following states: Florida, Georgia, North Carolina, South Carolina, and Tennessee.
• 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.

Base Compensation Range: $70,000 - $90,000 USD

• Competitive cash compensation
• Generous PTO
• Future focused 401k match
• Generous parental and caregiver leave
• Our core values are more than just a poster on the wall; they’re tangibly reflected in our work

Location Information

Unless otherwise specified, this role is remote. Remote team members must live and work in the United States 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.

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.