Senior Claims Adjuster, Workers Compensation

About the role

Pie Insurance is seeking a Senior Claims Adjuster for Workers Compensation who will own the full lifecycle of complex claims from initial setup through final closure. In this role, you will independently manage the entire workflow of workers' compensation claims while applying deep expertise in high dollar, high exposure cases. You will exercise judgment to evaluate claims, determine compensability, and execute mitigation strategies that protect both our customers and the company. This position requires strict adherence to Pie's Claims Best Practices and compliance with all regulatory and statutory mandates. You will act as a key liaison with internal stakeholders and external partners to ensure favorable outcomes and consistent delivery of an industry-leading customer experience.

Key facts

What you'll do

• Independently handle all aspects of the workers' compensation claims from set-up to closure.
• Evaluate and handle high dollar, high exposure, complex claims with precision and care.
• Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change.
• Mitigate the complex exposure while achieving the best possible outcome for all parties.
• Determine timely and accurate compensability decisions within statutory requirements.
• Set and adjust timely and accurate reserves within authority limits to ensure reserving activities align with case facts and company best practices.
• Ability to present claims to senior management, internal teams, and external stakeholders.
• Administer statutory medical and indemnity benefits in a timely manner throughout the life of the claim.
• Comply with all applicable statutory guidelines, rules, and regulations without exception.
• Control legal activity with defense counsel through the litigation process while actively managing legal fees and costs.
• Prioritize early resolution opportunities, evaluate claim exposure, and negotiate settlements strategically.
• Serve as a primary point of contact for partner agents and customers to provide guidance on claim processes and expectations.
• Assist in providing current claim status to agents and insureds, including coverage verification and loss run reports as needed.
• Provide excellent customer service to both internal and external customers and business partners at every touchpoint.
• Advocate to ensure that Pie maintains a leading claims customer experience across all interactions.
• Continuously improve claims operations by identifying gaps in SOPs, protocols, and processes and proposing actionable enhancements.

Requirements

• High School Diploma or equivalent is required for this position.
• Bachelor's Degree or equivalent experience with some college coursework is preferred for consideration.
• Minimum of 5-years workers' compensation claim adjusting experience is required, with carrier background being preferred.
• Preferred claims experience in 2 or more of the following jurisdictions: AL, AR, CO, CT, DC, DE, IA, IL, IN, KS, KY, LA, MI, MN, MO, MS, NE, NH, OK, RI, TX, VT, WI, WV.
• Demonstrated ability to evaluate and identify high dollar, high exposure, complex claims accurately and efficiently.
• Active licensing in applicable states is required to perform the essential functions of this role.
• Strong written and verbal communication skills are necessary to deliver complex information clearly to diverse audiences.
• Strong problem-solving skills must be present to manage complex tasks and navigate solutions with minimal guidance.
• High level of self-awareness regarding how individual tasks impact team performance and overall deliverables.
• Familiarity with G-Suite Tools and collaboration platforms such as Slack is preferred for effective teamwork.
• Advanced understanding of jurisdictional regulatory and statutory requirements is essential for compliance.
• Advanced knowledge of claim adjudication processes, medical protocols, and litigation management is required.
• Advanced analytical ability to synthesize multiple data points and take appropriate action across several focus areas.
• Demonstrated commitment to adhering to deadlines, quality standards, and regulatory compliance.
• Willingness to follow established procedures while applying critical thinking to improve outcomes.
• Capacity to work independently and as part of a collaborative team in a fast-paced environment.
• Readiness to maintain up-to-date knowledge of changes in workers' compensation laws and industry best practices.
• Professional demeanor and ownership of customer interactions at all times.

Nice to have

• Experience using G-Suite Tools and collaboration tools like Slack is preferred.
• Advanced knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements.
• Advanced knowledge and experience in claim adjudication, medical, and litigation management.
• Strong ability to analyze data from multiple sources and apply insights to decision-making.

Practical notes

This role operates within the United States under standard employment terms. Specific hours, travel expectations, visa sponsorship details, and application deadlines were not provided in the source material and are not specified here.