CA - Senior Claims Adjuster, Worker's Compensation

The role

The Senior Claims Adjuster will manage workers' compensation claims from set-up to closure. This role involves evaluating complex claims, determining compensability, and providing customer service to agents and customers.

What you will do

• Independently handle all aspects of workers' compensation claims from set-up to closure.
• Evaluate and handle high dollar, high exposure, complex claims.
• Conduct timely 3-point contact investigation.
• Determine timely and accurate compensability decisions within statutory requirements.
• Set and adjust timely/accurate reserves within authority limits.
• Present claims to senior management, internal and external stakeholders.
• Administer statutory medical and indemnity benefits.
• Control legal activity with defense counsel through the litigation process.
• Prioritize early resolution opportunities and negotiate settlement.
• Serve as a point of contact for partner agents and customers.

Required qualifications

• High School Diploma or equivalent
• Minimum of 5-years workers’ compensation claim adjusting experience
• Claims experience handling California WC claims
• Ability to evaluate and identify high dollar, high exposure, complex claims
• Active licensing in applicable states
• Strong communication (written and verbal) skills
• Strong problem-solving skills
• Advanced knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements
• Advanced knowledge and experience in claim adjudication, medical, and litigation management
• Advanced ability to analyze and take necessary action in multiple focus areas based on several data points
• Ability to make claim decisions to mitigate exposure while achieving the best outcome
• Ability to use skills to overcome conflict and reach beneficial outcomes

Nice to have

• Bachelor's Degree or equivalent experience with some college coursework
• carrier background
• Experience using G-Suite Tools and collaboration tools like Slack

Benefits

• Competitive cash compensation
• Comprehensive health plans
• Generous PTO
• Future focused 401k match
• Generous parental and caregiver leave
• Discretionary bonuses may be granted each year based on company performance

Before you apply

• Remote team members must live and work in the United States ( territories excluded ) and have access to reliable, high-speed internet.
• By submitting your application, you acknowledge and consent to Pie utilizing AI technologies to assist in your evaluation process.

About the company

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. They leverage technology to transform how small businesses buy and experience commercial insurance.