Complex Claims Adjuster, Workers Compensation at Pie Insurance

United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

InsuranceIndustries

Requirements

High School Diploma or equivalent
Advanced knowledge and experience with complex negotiation strategies, structured settlements, Medicare Set-Aside requirements, and overall risk evaluation and mitigation
Ability to independently handle catastrophic and large loss workers’ compensation claims from set-up to closure
Expertise in conducting timely 3-point contact investigations and continued investigation as facts change
Proficiency in determining timely and accurate compensability decisions within statutory requirements
Skills in setting and adjusting timely/accurate reserves consistent with case facts and company best practices
Capability to present claims to senior management, internal and external stakeholders
Experience in timely administration of statutory medical and indemnity benefits
Knowledge of compliance with all applicable statutory guidelines, rules, and regulations
Ability to control legal activity with defense counsel, manage legal fees and costs, and handle litigation processes
Proficiency in prioritizing early resolution opportunities, evaluating claim exposure, and negotiating settlements
Experience assessing claims for settlement value using rated ages, present value, Medicare set-asides, medical cost projections, and structured settlements
Ability to obtain annuity and structured settlement quotes
Willingness to attend virtual and in-person mediations, informal settlement conferences, and trials

Responsibilities

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
Present claims to senior management, internal and external stakeholders
Timely administer 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 settlements
Mitigate complex exposure while achieving the best outcome
Serve as a point of contact for partner agents and customers to provide general claim guidance and set claim process expectations
Provide claim status to agents and insureds, coverage verification, and loss run reports as necessary
Provide excellent customer service to internal/external customers and business partners
Work to continuously improve claims operations and address opportunities and gaps in claim service, handling SOPs, protocols, and processes
Direct a proactive litigation strategy to increase settlement opportunities
Assess claims for settlement value using rated ages, present value, Medicare set-asides, medical cost projections, and structured settlements; obtain settlement authority as required
Obtain annuity and structured settlement quotes
Attend virtual and in-person mediations, informal settlement conferences, and trials to represent Pie's interests
Participate in Claims Roundtable meetings and develop collaborative plans of action for aggressive claims handling
Create Claims Status Reports and establish timely, accurate reserves
Present large loss updates to internal and external partners
Collaborate with Complex Claims Practices Consultant and Claims Leadership to continuously improve claims operations and identify opportunities and gaps in claim service, handling SOPs, protocols, and processes

Skills

Key technologies and capabilities for this role

Workers Compensation ClaimsClaims AdjudicationCatastrophic Claims HandlingClaims InvestigationReserve ManagementComplex NegotiationStructured SettlementsMedicare Set-AsideRisk EvaluationRegulatory ComplianceClaims Best Practices

Questions & Answers

Common questions about this position

What is the salary or compensation for the Complex Claims Adjuster role?

This information is not specified in the job description.

Is this Complex Claims Adjuster position remote or does it require office work?

This information is not specified in the job description.

What key skills are required for the Complex Claims Adjuster role?

The role requires advanced knowledge of complex negotiation strategies, structured settlements, Medicare Set-Aside requirements, risk evaluation and mitigation, along with hands-on adjudication of catastrophic and large loss workers’ compensation claims.

What is the company culture like at Pie Insurance?

Pie Insurance has a diverse team of builders, dreamers, and entrepreneurs driven by core values and operating principles that guide every decision, with a mission to empower small businesses through affordable commercial insurance using technology.

What makes a strong candidate for the Complex Claims Adjuster position?

Strong candidates will have experience independently handling catastrophic and large loss workers’ compensation claims, conducting investigations, setting reserves, negotiating settlements, complying with regulations, and collaborating to improve claims processes.

Pie Insurance

Provides workers' compensation insurance for small businesses

About Pie Insurance

Pie Insurance provides workers' compensation insurance specifically designed for small businesses. This type of insurance helps cover wage replacement and medical benefits for employees who are injured while working. The company utilizes data-driven technology to offer competitive pricing and ensure that clients receive quality coverage. The process for obtaining insurance quotes is quick and user-friendly, taking only three minutes, which is particularly beneficial for small business owners who may not have the time to deal with complicated insurance procedures. Pie Insurance operates in 38 states and Washington, D.C., with plans for further expansion. The company aims to deliver trusted and efficient insurance services, promising potential savings of up to 30% on workers' compensation insurance. Its unique approach lies in leveraging technology to simplify the insurance process, making it easier and more affordable for small businesses.

Washington, District of ColumbiaHeadquarters

2017Year Founded

$603.4MTotal Funding

SERIES_DCompany Stage

Fintech, Financial ServicesIndustries

201-500Employees

Benefits

Competitive cash compensation

Equity

Comprehensive health plans

Generous PTO, including paid sick leave

Future focused 401k match

Generous parental & caregiver leave

Risks

Recent layoffs of 14% of workforce indicate potential financial instability.

Deteriorating funding environment may limit expansion and technology investments.

Increased competition from insurtech companies could pressure Pie to maintain competitive pricing.

Differentiation

Pie Insurance offers A.M. A-rated insurance with a simple online experience.

The company uses data analytics to accurately assess risks and price policies.

Pie Insurance provides quick insurance quotes, taking just three minutes for small businesses.

Upsides

Integration with Ivans Download could enhance operational efficiency and customer service.

Appointment of Audra Foglietta as CFO may drive financial performance and efficiencies.

Partnership with Endeavor Insurance Group could expand market reach and distribution channels.

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