Senior Claims Adjuster, Workers 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 Senior Claims Adjuster will play a critical 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 workers’ compensation claims from set-up to closure; Evaluate and handle high dollar, high exposure, complex claims; Conduct timely 3-point contact investigation; Mitigate 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; Present claims to senior management, internal and external stakeholders; Timely administration of statutory medical and indemnity benefits; Comply with applicable statutory guidelines, rules, and regulations; Control legal activity with defense counsel through litigation; Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement; Serve as point of contact for partner agents and customers; Provide claim status to agents and insureds, coverage verification and loss run reports; Provide excellent customer service; Advocate for leading claims customer experience; Continuously improve claims operations and identify opportunities and gaps

Requirements

High School Diploma or equivalent; Minimum of 5 years workers’ compensation claim adjusting experience; Ability to evaluate and identify high dollar, high exposure, complex claims; Active licensing in applicable states; Strong communication (written and verbal) skills; Strong problem-solving skills; Awareness of own tasks and how it impacts the team and deliverables; Advanced knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements; Advanced knowledge and experience in claim adjudication, medical, and litigation management; Advanced ability to analyze and take necessary action in multiple focus areas based on several data points; Ability to make claim decisions to mitigate exposure while achieving the best outcome; Ability to use skills to overcome conflict and reach beneficial outcomes; Ability to mentor junior adjusters

Nice to have

Bachelor's Degree or equivalent experience with some college coursework; Carrier background; Preferred claims experience in 2 or more of the following jurisdictions: AL, AR, CO, CT, DC, DE, FL, IA, IL, IN, KS, KY, LA, MI, MN, MO, MS, NE, NH, OK, RI, TX, VT, WI, WV; Experience using G-Suite Tools and collaboration tools like Slack

Benefits

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