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Claims Specialist
Workers’ Compensation, New York
Posted on 1/27/2023
Locations
New York, NY, USA
Experience Level
Entry
Junior
Mid
Senior
Expert
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 at least one Claims Adjuster License in one of the following states: 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
  • 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
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
Pie Insurance

201-500 employees

Small business insurance platform
Company Overview
Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. The company leverages technology to transform how small businesses buy and experience commercial insurance.
Benefits
  • Competitive cash compensation
  • Equity
  • Comprehensive health plans
  • Generous PTO, including paid sick leave
  • Future focused 401k match
  • Generous parental & caregiver leave
Company Core Values
  • Integrity
  • Ownership
  • Simplicity
  • Service