CA - Claims Adjuster, Workers Compensation

The role

The Claims Adjuster will manage workers' compensation claims from set-up to closure. This role involves conducting investigations, determining compensability, and managing reserves and benefits while providing customer service to agents and customers.

What you will do

• Independently handle all aspects of the workers’ compensation claims from set-up to closure.
• Conduct timely 3-point contact investigation.
• 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.
• Timely administration of statutory medical and indemnity benefits.
• Comply with all applicable statutory guidelines, rules, and regulations.
• Control legal activity with defense counsel through the litigation process.
• Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement.
• Serve as a point of contact for partner agents and customers.

Required qualifications

• High School Diploma or equivalent
• Minimum of 2-years workers’ compensation claims experience
• Claims experience working in CA
• Strong communication (written and verbal) skills
• Strong problem solving skills
• Awareness of your own tasks, and how it impacts the team and deliverables
• 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

Nice to have

• Bachelor's Degree or equivalent experience with some college coursework
• 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

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 our 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.