Senior Claims Adjuster – Worker's Compensation

🔥 13 minutes ago

🇺🇸 United States – Remote

💵 $95k - $120k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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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 workers’ compensation claims from set-up to closure. • Evaluate and handle high-dollar, high-exposure, complex claims. • Conduct timely 3-point contact investigations and continue investigating as case facts change. • Mitigate complex exposure while achieving the best outcome. • Determine timely and accurate 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. • Comply with applicable statutory guidelines, rules, and regulations. • Control legal activity with defense counsel while managing legal fees and costs. • Prioritize early resolution opportunities, evaluate exposure, and negotiate settlements. • Support partner agents and customers with claim guidance and process expectations. • Provide claim status, coverage verification, and loss run reports. • Improve claims operations, service processes, SOPs, protocols, and procedures.

🎯 Requirements

• High School Diploma or equivalent is required. • Minimum of 5-years workers’ compensation claim adjusting experience is required. • Claims experience handling California WC claims is required. • Requires active licensing in applicable states. • Ability to evaluate and identify high dollar, high exposure, complex claims. • Strong communication (written and verbal) skills. • Strong problem-solving skills to manage complex tasks with little guidance. • 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 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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