Claims Adjuster, Workers Compensation

Posted 11 Days Ago
Hiring Remotely in United States
Remote
70K-90K Annually
Junior
Fintech • Insurance • Machine Learning • Other • Analytics • Automation
Safety First, Then Pie Insurance
The Role
The Claims Adjuster will manage all aspects of workers' compensation claims from initiation to closure, ensuring compliance with statutory requirements and delivering excellent customer service. Responsibilities include investigating claims, making compensability decisions, negotiating settlements, and controlling legal activity.
Summary Generated by Built In

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance.

 

Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make.

The Claims Adjuster will play a vital role in delivering quality claim file management and an industry-leading customer claims experience. This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers. Pie's Claim Team is 100% remote-based and strategically deployed across the states we write business in. Pie dedicates significant resources and support to ensuring our remote Pie-oneers are set up for success!

How You’ll Do It

Claims Technical Management

  • Independently handle all aspects of the workers’ compensation claims from set-up to closure.
  • Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change.
  • Mitigate claim  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.
  • 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.

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.
  • Assist as necessary in providing claim status to agents and insureds, coverage verification and loss run reports, etc.
  • 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. 

The Right Stuff

  • 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. 
  • Experience in the following states preferred: TX, IA, IL, KS, MI, NJ, OK, PA, WI and CA.
  • 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.
  • 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.
  • Ability to make claim decisions to mitigate exposure while achieving the best outcome.

Base Compensation Range

$70,000$90,000 USD

Compensation & Benefits 
  • Competitive cash compensation
  • A piece of the pie (in the form of equity)
  • Comprehensive health plans
  • Generous PTO
  • Future focused 401k match
  • Generous parental and caregiver leave
  • Our core values are more than just a poster on the wall; they’re tangibly reflected in our work 

Our goal is to make all aspects of working with us as easy as pie. That includes our offer process. When we’ve identified a talented individual who we’d like to be a Pie-oneer , we work hard to present an equitable and fair offer. We look at the candidate’s knowledge, skills, and experience, along with their compensation expectations and align that with our company equity processes to determine our offer ranges. 

Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members.

Location Information 

Unless otherwise specified, this role has the option to be hybrid or remote. Hybrid work locations provide team members with the flexibility of working partially from our Denver office and from home. Remote team members must live and work in the United States* (*territories excluded), and have access to reliable, high-speed internet.

Additional Information

Pie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic.

Pie Insurance participates in the E-Verify program. Please click here, here and here for more information.

Pie Insurance is committed to protecting your personal data. Please review our Privacy Policy.  

Safety First: Pie Insurance is committed to your security during the recruitment process. We will never ask you for credit card information or ask you to purchase any equipment during our interview or onboarding process.

Pie Insurance Announces $315 Million Series D Round of Funding

Built In honors Pie in its 2024 Best Places to Work Awards

Pie Insurance Named a Leading Place to Work in Colorado

 

#LI-REMOTE

#BI-REMOTE

What the Team is Saying

Elizabeth
Francesca
The Company
Denver, CO
400 Employees
Remote Workplace
Year Founded: 2017

What We Do

Pie is transforming small business insurance. Our team of seasoned technology and insurance experts are on a mission to empower small businesses to thrive by making insurance affordable and as easy as pie.

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Pie Insurance Offices

Remote Workspace

Employees work remotely.

As a remote first company, Pie supports our Pie-oneers in working in a U.S. location that’s best for them. Our Denver, CO office is available for larger team events and is open for local employees to use whenever they want.

Typical time on-site: None
Denver, CO

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