Remote Workers’ Comp Claims Specialist

Pie Insurance; United States; Remote; USD 80,000 - 100,000; Full time

Benefits offered by this job

Competitive cash compensation

Comprehensive health plans

Generous PTO

Future focused 401k match

Generous parental and caregiver leave

Core values in daily work

Job summary

Pie Insurance is seeking a Claims Adjuster to independently manage workers’ compensation claims from setup to closure, ensuring timely investigations and favorable outcomes. You’ll collaborate with agents, insureds, and TPAs to deliver a leading claims experience, while ensuring regulatory compliance and accurate reserving.

The role requires at least 2 years of CA workers’ compensation claims experience, strong communication, and problem-solving skills.

Qualifications

• 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 CA is required.
• 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.

Responsibilities

• 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.

Skills

Strong communication

Problem solving

G-Suite tools

Slack

Claim adjudication

Medical management

Litigation management

Regulatory knowledge

Education

High School Diploma or equivalent

Bachelor’s degree or equivalent experience

Tools

G-Suite

Slack

Job description

Pie Insurance is seeking a Claims Adjuster to independently manage workers’ compensation claims from setup to closure, ensuring timely investigations and favorable outcomes. You’ll collaborate with agents, insureds, and TPAs to deliver a leading claims experience, while ensuring regulatory compliance and accurate reserving.

The role requires at least 2 years of CA workers’ compensation claims experience, strong communication, and problem-solving skills.