Complex Claims Adjuster

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $100k - $125k / year

⏰ Full Time

🟠 Senior

🔴 Lead

📋 Claims Specialist

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This company has sponsored H1B visas in the past.

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Pie Insurance

WebsiteLinkedInAll Job Openings

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 catastrophic and large loss workers’ compensation claims from set-up to closure. • Conduct timely 3-point contact investigations and continued investigations as case facts change. • Determine compensability decisions within statutory requirements. • Set and adjust reserves within authority limits. • Present claims to senior management and internal and external stakeholders. • Administer statutory medical and indemnity benefits throughout the claim lifecycle. • Comply with statutory guidelines, rules, and regulations. • Manage defense counsel, litigation activity, legal fees, and costs. • Identify early resolution opportunities, evaluate claim exposure, and negotiate settlements. • Mitigate complex exposure while achieving favorable outcomes. • Serve as a point of contact for partner agents and customers, providing claim guidance and setting process expectations. • Provide claim status, coverage verification, and loss run reports. • Improve claims operations, service processes, SOPs, protocols, and processes. • Direct proactive litigation strategies and assess settlement values using rated ages, present value, Medicare set-asides, medical cost projections, and structured settlements. • Obtain annuity and structured settlement quotes and settlement authority. • Attend virtual and in-person mediations, informal settlement conferences, and trials. • Participate in Claims Roundtable meetings and develop collaborative action plans. • Create claims status reports and present large loss updates. • Collaborate with the Complex Claims Practices Consultant and Claims Leadership to improve claims operations.

🎯 Requirements

• High School Diploma or equivalent is required. • Bachelor's Degree or equivalent experience with some college coursework is preferred. • Minimum of 7 years workers’ compensation claim adjusting experience is required (carrier background, preferred). • 2+ years of catastrophic claim handling experience. • Ability to evaluate and identify high dollar, high exposure, complex claims. • Strong claims handling experience within the Southeast region preferred, with expertise in Florida, Georgia, and/or North Carolina. • Willingness to expand jurisdictional knowledge and obtain additional state licenses as business needs evolve. • Requires active licensing in applicable states. • Advanced communication (written and verbal) skills. • Advanced problem-solving skills. • 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. • 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 may be granted annually to eligible team members

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