Remote Medical-Only Claims Adjuster

Pie Insurance; United States; Remote; USD 60,000 - 75,000; Full time

Benefits offered by this job

Competitive cash compensation

Comprehensive health plans

Generous PTO

Future 401k match

Parental and caregiver leave

Job summary

Pie Insurance is hiring a Medical Only Claims Adjuster to independently manage CA workers’ compensation medical-only claims from setup to closure, ensuring medical management and timely resolution in cooperation with agents and insureds.

The role emphasizes high-quality customer service, adherence to statutory requirements, and proactive risk mitigation to deliver favorable claim outcomes.

Qualifications

• High school diploma or equivalent required; bachelor’s degree preferred.
• 1 year of workers’ compensation medical-only claims experience required.
• Experience handling CA claims; additional states AZ/UT preferred.
• Strong communication skills and ability to collaborate with partners.

Responsibilities

• Independently manage all CA workers’ compensation medical-only claims from setup to closure.
• Perform timely 2-point contact investigations focusing on medical management and possible lost time.
• Mitigate claim exposure while achieving optimal outcomes and timely reserves updates.
• Make timely, legally compliant compensability decisions within statutory requirements.
• Administer statutory medical benefits and use Utilization Review when appropriate.
• Provide claim status updates to agents/insureds and maintain service excellence.
• Negotiate liens and resolve medical liens to appropriate resolutions.

Skills

Communication

Attention to detail

Team collaboration

Adaptability

Education

High School Diploma or equivalent

Bachelor's degree preferred

Tools

G-Suite

Slack

Job description

Pie Insurance is hiring a Medical Only Claims Adjuster to independently manage CA workers’ compensation medical-only claims from setup to closure, ensuring medical management and timely resolution in cooperation with agents and insureds.

The role emphasizes high-quality customer service, adherence to statutory requirements, and proactive risk mitigation to deliver favorable claim outcomes.