About the job
At Pie Insurance, our mission is to empower small businesses by making commercial insurance accessible and straightforward. We utilize innovative technology to transform the way small enterprises engage with commercial insurance.
Our diverse team of builders, dreamers, and entrepreneurs embodies the core values and operating principles that drive every decision we make, much like our small business customers.
The Senior Claims Adjuster will be pivotal in ensuring superior claim file management and delivering an exceptional customer claims experience. This role requires strict adherence to Pie’s Claims Best Practices along with compliance with regulatory and statutory requirements. You will collaborate with internal and external stakeholders to achieve outstanding performance, identify claim mitigation opportunities, and deliver favorable outcomes for Pie’s customers.
Your Responsibilities
Claims Technical Management:
- Independently manage all aspects of workers’ compensation claims from initiation to resolution.
- Evaluate and oversee high-value, complex claims.
- Conduct timely investigations with a focus on evolving case facts.
- Mitigate complex exposures to achieve optimal outcomes.
- Make timely and accurate compensability decisions in line with statutory requirements.
- Set and adjust reserves accurately within authority limits in alignment with case facts and company practices.
- Present claims to senior management and stakeholders effectively.
- Administer statutory medical and indemnity benefits throughout the claim lifecycle.
- Ensure compliance with all applicable statutory guidelines, rules, and regulations.
- Control legal activities in collaboration with defense counsel while managing costs and legal fees.
- Prioritize early resolutions, assess claim exposures, and negotiate settlements.
Claims Customer Service:
- Act as a primary contact for partner agents and customers, providing guidance and setting expectations for the claims process.
- Assist in delivering claim status updates to agents and insureds, verify coverage, and address inquiries.
