Claims Adjuster, Workers Compensation

Job not on LinkedIn

🔥 12 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $80k - $100k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Pie Insurance

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201 - 500 employees

🛡️ Insurance

💳 Fintech

🤝 B2B

Insurance • Fintech • B2B

Pie Insurance is transforming small business insurance by making it less expensive, simpler, and more transparent for small business owners. With a team of seasoned technology and insurance experts, Pie Insurance is dedicated to enhancing the insurance experience, particularly focused on workers' compensation and InsureTech innovations.

📋 Description

• Independently handle all aspects of workers’ compensation claims from set-up to closure. • Conduct timely 3-point contact investigations and continue investigating as case facts change. • Mitigate claim exposure and determine accurate compensability decisions within statutory requirements. • Set and adjust reserves within authority limits. • Administer statutory medical and indemnity benefits throughout the claim lifecycle. • Comply with applicable statutory guidelines, rules, and regulations. • Manage defense counsel, legal activity, fees, and costs through litigation. • Prioritize early resolution opportunities, evaluate exposure, and negotiate settlements. • Serve as a contact for partner agents and customers, providing claim guidance and process expectations. • Provide claim status, coverage verification, loss run reports, and customer service. • Collaborate with TPA adjusters and claims partners to optimize outcomes and customer experience. • Continuously improve claims operations, service, SOPs, protocols, and processes.

🎯 Requirements

• 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. • Strong problem solving skills to manage complex tasks and work through solutions with little guidance and direction. • 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. • 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. • Must live and work in the United States, territories excluded. • Must have access to reliable, high-speed internet.

🏖️ Benefits

• Competitive cash compensation • Comprehensive health plans • Generous PTO • Future focused 401k match • Generous parental and caregiver leave • Discretionary bonuses may be granted to eligible team members

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