Complex Claims Adjuster, Workers Compensation

Complex Claims Adjuster, Workers Compensation

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.

The Complex Claims Adjuster will play a critical role in delivering quality claim file management and an industry-leading customer claims experience, by providing hands-on adjudication of catastrophic and large loss claims. This will be completed by adhering to Pie's Claims Best Practices, complying with regulatory and statutory requirements, and applying advanced knowledge and experience with complex negotiation strategies, structured settlements, Medicare Set-Aside requirements, and overall risk evaluation and mitigation. 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.

Additionally, the Complex Claims Adjuster will collaborate with the Complex Claims Practices Consultant and Claims leadership to continually seek out ways in which to improve claims processes and protocols.

How You'll Do It

Claims Technical Management :

• Independently handle all aspects of catastrophic and large loss 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.
• 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.
• Mitigate the complex exposure while achieving the best outcome.

Claims Customer Service :

Claims Resolution Management :

Collaboration & Innovation :

The Right Stuff

The use of AI in Application Review : To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process.

Compensation & Benefits

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 is remote. 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.