Claims Claims Adjuster, Workers Compensation - California

Pie Insurance Group; California (MO); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Pie Insurance Group is seeking a Claims Adjuster to manage all aspects of workers' compensation claims while building relationships with clients and providing excellent customer service. Ideal candidates will possess strong problem-solving skills, a high school diploma or equivalent, and have at least two years of relevant experience. This role can be hybrid or remote, with a competitive salary range.

Benefits

Competitive cash compensation

Equity participation

Generous PTO

401k match

Generous parental and caregiver leave

Qualifications

• Minimum of 2-years workers’ compensation claims experience required.
• Strong communication skills needed for effective information delivery.
• Knowledge of jurisdictional regulatory and statutory requirements.

Responsibilities

• Handle all aspects of workers’ compensation claims from setup to closure.
• Serve as a point of contact for partner agents and customers.
• Mitigate claim exposure while achieving the best outcome.

Skills

Communication

Problem Solving

Claims Adjudication

Education

High School Diploma or equivalent

Bachelor's Degree or equivalent experience

Tools

G-Suite

Collaboration Tools (Slack)

Job description

United States

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 bycore 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.
• Experience in the following states preferred: TX, IA, IL, KS, MI, NJ, OK, PA, WI and CA
• 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.

The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. All AI-reviewed applications are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process.

Base Compensation Range

$70,000 - $90,000 USD

• Competitive cash compensation
• A piece of the pie (in the form of equity)
• 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

Our goal is to make all aspects of working with us as easy as pie. That includes our offer process. When we’ve identified a talented individual who we’d like to be a Pie-oneer , we work hard to present an equitable and fair offer.We look at the candidate’s knowledge, skills, and experience, along with their compensation expectations and align that with our company equity processes to determine our offer ranges.

Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members.

Location Information

Unless otherwise specified, this role has the option to be hybrid or remote. Hybrid work locations provide team members with the flexibility of working partially from our Denver office and from home. 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.

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