Remote Senior Workers' Comp Claims Adjuster

Pie Insurance; Northern (KY); Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Competitive cash compensation

Generous PTO

Future focused 401k match

Generous parental and caregiver leave

Job summary

Pie Insurance is hiring a Senior Claims Adjuster in the United States. The role handles workers’ compensation claims from setup to closure, focusing on high-dollar, complex cases while ensuring regulatory compliance and favorable outcomes.

The position emphasizes excellent customer service and ongoing process improvements. The candidate should have a minimum of 5 years of claims adjusting experience, active state licenses, and strong communication and analytical skills.

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).
• Preferred claims experience in FL, GA, NC, SC, and TN.
• Active licensing in applicable states is required.
• Advanced knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements.
• Experience using G-Suite Tools and collaboration tools like Slack is preferred.

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.
• Ability to 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.
• 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.
• Mentor junior adjusters.

Skills

Communication skills

Problem-solving

Mentoring

Team collaboration

Education

High School Diploma or equivalent

Bachelor's degree or equivalent experience

Tools

G-Suite

Slack

Job description

Pie Insurance is hiring a Senior Claims Adjuster in the United States. The role handles workers’ compensation claims from setup to closure, focusing on high-dollar, complex cases while ensuring regulatory compliance and favorable outcomes.

The position emphasizes excellent customer service and ongoing process improvements. The candidate should have a minimum of 5 years of claims adjusting experience, active state licenses, and strong communication and analytical skills.