CA - Senior Claims Adjuster, Worker's 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. 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.

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.

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.

and CMS/MSA

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. Ability to mentor junior adjusters.

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.

claim adjusting experience is required (carrier background, preferred). Claims experience handling California WC claims is required. Ability to evaluate and identify high dollar, high exposure, complex claims.

Requires active licensing in applicable states 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.

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. 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.