Complex Claims Adjuster, Workers Compensation (California) 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

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 settlement
Mitigate the complex exposure while achieving the best outcome
Serve as a point of contact for partner agents and customers to provide general claim guidance and help set claim process expectations
Provide claim status to agents and insureds, coverage verification and loss run reports, etc. 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. Develop a collaborative plan 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 look at opportunities and gaps in claim service, handling SOPs, protocols and processes

Skills

Workers Compensation Claims

Claims Adjudication

Catastrophic Claims

Claims Investigation

Reserving

Negotiation Strategies

Structured Settlements

Medicare Set-Aside

Risk Evaluation

Regulatory Compliance

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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