The Claims Adjuster (Arizona jurisdiction) 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.
- 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.
- 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.
#LI-MW1
Compensation & Benefits
- Competitive cash compensation
- A piece of the pie (in the form of equity)
- 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
Our goal is to make all aspects of working with us as easy as pie. That includes our offer process. When we’ve identified a talented individual who we’d like to be a Pie-oneer , we work hard to present an equitable and fair offer. We look at the candidate’s knowledge, skills, and experience, along with their compensation expectations and align that with our company equity processes to determine our offer ranges.
Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members.
Location Information
Unless otherwise specified, this role has the option to be hybrid or remote. Hybrid work locations provide team members with the flexibility of working partially from our Denver or DC office and from home. 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.
Pie Insurance Announces $315 Million Series D Round of Funding
