VP, Claims Adjudication

About the Role

The Vice President of Claims Adjudication at Pie Insurance architects and owns the complete end-to-end claims flow for small business clients. This position carries significant responsibility, as decisions made daily shape customer trust and company integrity. The role involves leading adjudication teams while carefully balancing established policy rules with nuanced human outcomes. Success in this position requires strategic vision and operational precision to deliver fair and efficient claim resolutions.

Pie Insurance exists to make commercial insurance affordable and straightforward for small businesses. Leveraging technology, the company transforms how small businesses purchase and experience insurance protection. This role reports directly to the Chief Claims Officer and is integral to executing the company's overarching claims strategy.

Key Responsibilities

This position is responsible for the full lifecycle of claims adjudication, from initial intake to final settlement. You will design and implement the intake rhythm for all claims information and necessary documentation. A core function involves building and refining adjudication logic and specific rules to effectively manage workers compensation outcomes.

You will exercise sound judgment when reviewing complex cases and large loss claims. A primary duty is shipping decisions that strike the right balance between empathetic customer care and strict fiscal responsibility. You will partner closely with technology and product teams to shape and improve claims workflow solutions.

Championing the adoption of new tools and methodologies is essential to enhance accuracy and clarity in the adjudication process. You will provide guidance to team members through coaching, goal setting, and clear performance expectations. Monitoring key metrics and industry trends will be ongoing to ensure loss ratios remain healthy and operations are efficient.

Organizational Leadership

You will lead and oversee Pie's claims adjudication function across all operating jurisdictions. This includes planning and directing all aspects of claims adjudication operations, managing both daily activities and long-term strategic initiatives. You are responsible for implementing claims programs specifically for workers compensation.

The role serves as the lead claims adjudication authority, bringing expert claims experience to the Pie Executive Team. You will direct the quarterly review and settlement of large loss and catastrophe claims. Developing, guiding, and refining claims adjudication procedures and policies to enhance processing, investigation, and settlement of claims is a core function.

You will determine the claims adjudication team's organizational structure, including expectations, span of control, and role definitions. Developing claims adjudication objectives and goals in direct support of Pie's OKRs is required. This involves developing, measuring, and coaching to performance and productivity goals and measurements for team members.

Building a strong team of claim talent with a strong customer focus is a priority. You are responsible for cultivating a diverse, equitable, and inclusive culture within the claims adjudication team. This includes leading and developing Directors and Senior Managers by setting goals, assigning work, reviewing performance, and managing staff activities, coaching, and mentoring.

Collaboration and Strategy

Collaboration is central to this role. You will work with the Chief Claims Officer in the design and execution of Pie's overall claims strategy. Contributing claims adjudication expertise and insights to inform enterprise-wide claims initiatives is expected. You will partner with Claims leadership on strategic planning and departmental objectives.

Ensuring that claims adjudication operations align with and actively support broader Claims strategy is a critical duty. This involves close coordination with technology and product leadership to integrate adjudication processes with the company's technology roadmap and vision for automation.

Qualifications

Candidates must possess three to five years of experience managing claims teams within an insurance environment. A deep understanding of workers compensation policies and adjudication regulations is mandatory. Demonstrated strong written and verbal communication skills are required for interacting with executives and partners.

The ability to handle sensitive data and maintain strict confidentiality at all times is non-negotiable. Candidates must be able to operate with integrity and professionalism in a high-stakes environment.

Compensation and Location

The position offers a competitive annual compensation package of $140,000.00. The role is based in the United States and requires full-time engagement.

Nice to Have

Prior experience with insurance technology platforms and automation tools is a distinct advantage. Familiarity with systems that enable workflow automation and data analysis is highly desirable.

Skills and Tools

Proficiency in workers compensation, claims adjudication, data analysis, and insurance regulations is essential. The role requires a detail-oriented mindset capable of navigating complex requirements while keeping the customer experience at the forefront.

Practical Notes

Details regarding the application process and specific requirements should be confirmed Ensure all information provided aligns with the current opportunity before submission.