Senior Claims Adjuster
Workers’ Compensation, Southeast
Confirmed live in the last 24 hours
Pie Insurance

201-500 employees

Online platform simplifying small business insurance
Company Overview
Pie Insurance is a leading company in the small business insurance sector, leveraging seasoned expertise in technology and insurance to offer cost-effective, simplified, and transparent solutions. Their competitive edge lies in their efficient online platform, which allows business owners to receive a quote within just 3 minutes, significantly reducing time and effort. This customer-centric approach, combined with their commitment to transparency, positions Pie Insurance as a strong industry leader.
Financial Services
Data & Analytics

Company Stage

Series D

Total Funding

$621M

Founded

2017

Headquarters

Washington, District of Columbia

Growth & Insights
Headcount

6 month growth

-1%

1 year growth

-1%

2 year growth

36%
Locations
United States
Experience Level
Entry
Junior
Mid
Senior
Expert
Desired Skills
Customer Service
Data Analysis
Management
Sales
Communications
Quality Assurance (QA)
CategoriesNew
Sales & Account Management
Legal & Compliance
Requirements
  • High School Diploma or equivalent is required
  • Bachelor's Degree or equivalent experience with some college coursework is preferred
  • Minimum of 5-years workers' compensation claim adjusting experience is required (carrier background, preferred)
  • Ability to evaluate and identify high dollar, high exposure, complex claims
  • Requires at least one Claims Adjuster License in one of the following states: CA, NY, IL, IN, MO, NE, WI, FL, GA (multiple states preferred)
  • 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
  • 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
Responsibilities
  • Claims Technical Management
  • Independently handle all aspects of the workers' compensation claims from set-up to closure
  • Evaluate and handle high dollar, high exposure, complex claims
  • Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change
  • Mitigate the 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 to ensure reserving activities are consistent with the case facts and company best practices
  • Ability to present claims to senior management, internal and external stakeholders
  • Timely administration of statutory medical and indemnity benefits throughout the life of the claim
  • Comply with all applicable statutory guidelines, rules, and regulations
  • Control legal activity with defense counsel through the litigation process while managing legal fees and costs
  • Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement
  • Acts as a subject matter expert for the department
  • 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
  • Provide excellent customer service to internal and external customers and business partners
  • 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