Claims Adjuster, Worker's Compensation

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. 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.

Responsibilities

Independently handle all aspects of the workers’ compensation claims from set-up to closure; Conduct timely 3-point contact investigation; 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; Timely administration of statutory medical and indemnity benefits; Comply with applicable statutory guidelines, rules, and regulations; Control legal activity with defense counsel through the litigation process; Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement; Serve as a point of contact for partner agents and customers; Assist in providing claim status, coverage verification and loss run reports; Provide excellent customer service to internal and external customers and business partners; Participate in interactions with TPA adjusters and claims partners; Advocate to ensure leading claims customer experience; Work to continuously improve claims operations

Requirements

High School Diploma or equivalent is required; 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; Strong problem solving skills; Awareness of your own tasks and how it impacts the team and deliverables; 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; Ability to use skills to overcome conflict and reach beneficial outcomes; Ability to make claim decisions to mitigate exposure while achieving the best outcome

Nice to have

Bachelor's Degree or equivalent experience with some college coursework is preferred; Experience using G-Suite Tools, and collaboration tools like Slack is preferred

Benefits

Competitive cash compensation; Comprehensive health plans; Generous PTO; Future focused 401k match; Generous parental and caregiver leave; Discretionary bonuses