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Pie Insurance is seeking an experienced Complex Claims Adjuster to manage catastrophic and large loss workers' compensation claims. This role is central to delivering quality claim file management and an industry-leading customer claims experience.
You will independently handle all aspects of complex workers' compensation claims from setup through closure, including conducting timely investigations, making compensability determinations, setting and adjusting reserves, and managing statutory medical and indemnity benefits. You'll control legal activity with defense counsel, manage legal fees, and prioritize early resolution opportunities while negotiating settlements to achieve favorable outcomes.
Key responsibilities include:
- Independently adjudicate catastrophic and large loss claims while adhering to Pie's Claims Best Practices and regulatory requirements
- Conduct thorough 3-point contact investigations with continued investigation as case facts evolve
- Determine timely and accurate compensability decisions within statutory requirements
- Set and adjust reserves consistent with case facts and company best practices
- Present claims to senior management and internal/external stakeholders
- Serve as a point of contact for partner agents and customers, providing claim guidance and status updates
- Direct proactive litigation strategy to increase settlement opportunities
- Assess claims for settlement value using rated ages, present value, Medicare Set-Asides, and structured settlements
- Attend mediations, settlement conferences, and trials to represent Pie's interests
- Collaborate with Claims leadership to continuously improve claims operations, processes, and protocols
- Participate in Claims Roundtable meetings and create Claims Status Reports
You'll work with internal and external partners to identify and pursue claim mitigation opportunities while delivering best-in-class performance. This role requires strong negotiation skills, advanced knowledge of complex claim handling, and expertise in structured settlements and risk evaluation.
