Claims Adjuster, Worker's Compensation

Pie Insurance · United States

Pay

$70k

Setting

Remote

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Back to jobs Claims Adjuster, Worker's Compensation United States Apply 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. 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. Claims experience working in the following states: Florida, Georgia, North Carolina, South Carolina, and Tennessee. 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. 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. Base Compensation Range $70,000 - $90,000 USD Compensation & Benefits Competitive cash compensation 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 Making every part of working with us "Easy as Pie" - including our offer process. When we find someone we'd like as a Pie-oneer (a member of our team), we move quickly to put together a fair offer based on your skills, experience, location, and compensation expectations. 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. 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 Named to 2025 America's Best Startup Employers Pie Insurance 2025 State of Workplace Safety Report #LI-REMOTE #BI-REMOTE Apply for this job * indicates a required field Autofill my application First Name* Last Name* Email* Phone Country* Phone* Resume/CV* Attach Attach Dropbox Google Drive Enter manually Enter manually Accepted file types: pdf, doc, docx, txt, rtf Cover Letter Attach Attach Dropbox Google Drive Enter manually Enter manually Accepted file types: pdf, doc, docx, txt, rtf LinkedIn Profile Website How did you hear about this opportunity?* Select... Will you now or in the future require our company to sponsor your employment visa?* Select... Are you legally authorized to work in the United States?* Select... Address Line 1* Address Line 2 (Optional) City* State* Select... Zip Code* Which states do you have Workers' Compensation claims handling experience in?* Are you licensed or certified to handle Workers' Compensation claims in any specific states? If so, please list them* How would you rate your familiarity with Workers' Compensation claims?* Select... U.S. Standard Demographic Questions We invite applicants to share their demographic background. If you choose to complete this survey, your responses may be used to identify areas of improvement in our hiring process. How would you describe your gender identity? (mark all that apply) Select... How would you describe your racial/ethnic background? (mark all that apply) Select... How would you describe your sexual orientation? (mark all that apply) Select... Do you identify as transgender? Select... Do you have a disability or chronic condition (physical, visual, auditory, cognitive, mental, emotional, or other) that substantially limits one or more of your major life activities, including mobility, communication (seeing, hearing, speaking), and learning? Select... Are you a veteran or active member of the United States Armed Forces? Select... Voluntary Self-Identification For government reporting purposes, we ask candidates to respond to the below self-identification survey. Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiring process or thereafter. Any information that you do provide will be recorded and maintained in a confidential file. As set forth in Pie Insurance’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law. Gender Select... Are you Hispanic/Latino? Select... Race & Ethnicity Definitions If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection. As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categories is as follows: A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability. A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service. An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense. An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. Veteran Status Select... Voluntary Self-Identification of Disability Form CC-305 Page 1 of 1 OMB Control Number 1250-0005 Expires 07/31/2029 Why are you being asked to complete this form? We are a federal contractor or subcontractor. The law requires us to provide equal employment opportunity to qualified people with disabilities. We have a goal of having at least 7% of our workers as people with disabilities. The law says we must measure our progress towards this goal. To do this, we must ask applicants and employees if they have a disability or have ever had one. People can become disabled, so we need to ask this question at least every five years. Completing this form is voluntary, and we hope that you will choose to do so. Your answer is confidential. No one who makes hiring decisions will see it. Your decision to complete the form and your answer will not harm you in any way. If you want to learn more about the law or this form, visit the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP) website at www.dol.gov/ofccp. How do you know if you have a disability? A disability is a condition that substantially limits one or more of your “major life activities.” If you have or have ever had such a condition, you are a person with a disability. Disabilities include, but are not limited to: Alcohol or other substance use disorder (not currently using drugs illegally) Autoimmune disorder, for example, lupus, fibromyalgia, rheumatoid arthritis, HIV/AIDS Blind or low vision Cancer (past or present) Cardiovascular or heart disease Celiac disease Cerebral palsy Deaf or serious difficulty hearing Diabetes Disfigurement, for example, disfigurement caused by burns, wounds, accidents, or congenital disorders Epilepsy or other seizure disorder Gastrointestinal disorders, for example, Crohn's Disease, irritable bowel syndrome Intellectual or developmental disability Mental health conditions, for example, depression, bipolar disorder, anxiety disorder, schizophrenia, PTSD Missing limbs or partially missing limbs Mobility impairment, benefiting from the use of a wheelchair, scooter, walker, leg brace(s) and/or other supports Nervous system condition, for example, migraine headaches, Parkinson’s disease, multiple sclerosis (MS) Neurodivergence, for example, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, dyslexia, dyspraxia, other learning disabilities Partial or complete paralysis (any cause) Pulmonary or respiratory conditions, for example, tuberculosis, asthma, emphysema Short stature (dwarfism) Traumatic brain injury Disability Status Select... 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Listed by Pie Insurance for a position based in the United States. Employers on this board attest they are hiring domestically.