INACTIVE
Full-Time
Claims Specialist
Online platform simplifying small business insurance
Data & Analytics
Financial Services
$2
Junior
California, USA
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
- Requires a Claims Adjuster License in the following state: California
- Strong communication (written and verbal) skills, to deliver more complex information effectively
- Strong problem solving skills to be able to manage complex tasks and work through to solutions with little guidance and direction
- Awareness of your own tasks, and how it impacts the team and deliverables
- Experience using G-Suite Tools, and collaboration tools like Slack is preferred
- Developed 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, based on several data points
- Ability to use skills to overcome conflict and reach beneficial outcomes
- Bilingual in English and Spanish (oral and written) is preferred
Responsibilities
- Claims Quality Assurance (QA)
- Responsible for ensuring claims are handled in accordance with established guidelines and service instructions
- Ensures timely completion of file reviews, calibration sessions and analysis reports
- Identify claim handling trends by applying industry knowledge of the claims process, policies & procedures, and regulatory environment
- Meet regularly with Claims Leadership to provide QA results and recommendations for opportunities for improvement
- Claims Technical Oversight
- Provide technical direction on claim decisions and resolution in partnership with our external Third Party Administrator (TPA) partner within the assigned authority level
- Assist as necessary in providing claim status to agents and insureds, coverage verification and loss run reports, etc
- Claims Customer Service
- Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations
- Participate in interactions with TPA adjusters and claims partners to drive optimized claims outcomes and top-notch claims experience
- Advocate to ensure that Pie has a leading claims customer experience
- Work to continuously improve our claims operations and look at opportunities and gaps in claim service, handling SOPs, protocols and processes
- Analytics
- Support Pie's efforts to gather data to better inform our decisions, reporting and overall performance
- Use data to generate reports to inform on claims program trends and performance to goals
- Work collaboratively with Pie leaders and teams in Product, Underwriting, Compliance, Sales, and Customer Success to analyze data and metrics
- (
- Territories excluded), and have access to reliable, high-speed internet
Company Stage
Series D
Total Funding
$621M
Headquarters
Washington, District of Columbia
Founded
2017
Growth & Insights
Headcount
6 month growth
↑ 0%1 year growth
↓ -4%2 year growth
↑ 26%Benefits
Competitive cash compensation
Equity
Comprehensive health plans
Generous PTO, including paid sick leave
Future focused 401k match
Generous parental & caregiver leave
INACTIVE