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Salary: USD 60,000 - 75,000 / annual
Pie Insurance is seeking a Medical Only Claims Adjuster to manage workers' compensation medical-only claims from setup through closure. This role is central to delivering quality claim file management and an industry-leading customer claims experience while adhering to Pie's Claims Best Practices and regulatory requirements.
Key Responsibilities:
Claims Technical Management:
- Independently handle all aspects of workers' compensation medical-only claims from setup to closure
- Conduct timely two-point contact investigations, focusing on continued medical management, potential lost-time benefits, and claim closure as case facts evolve
- Mitigate claim exposure while achieving optimal outcomes
- Make timely and accurate compensability decisions within statutory requirements
- Set and adjust reserves within authority limits, ensuring consistency with case facts and company best practices
- Administer statutory medical benefits throughout the claim lifecycle
- Apply Utilization Review where appropriate and pay medical bills within required timeframes
- Comply with all applicable statutory guidelines, rules, and regulations
- Identify and escalate claims meeting indemnity conversion criteria
- Resolve medical treatment issues to facilitate claim closure
- Maintain and negotiate lien resolution claims to appropriate resolution
Claims Customer Service:
- Serve as a point of contact for partner agents and customers, providing claim guidance and setting process expectations
- Provide claim status updates, coverage verification, and loss run reports as needed
- Deliver excellent customer service to internal and external stakeholders
- Advocate for Pie's leading claims customer experience
- Identify opportunities and gaps in claim service, SOPs, protocols, and processes for continuous improvement
About Pie Insurance:
Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and accessible. The company leverages technology to transform how small businesses buy and experience commercial insurance.
Requirements:
- High School Diploma or equivalent (required)
- Bachelor's Degree or equivalent experience with some college coursework (preferred)
- Minimum 1 year of workers' compensation claims experience as a Medical Only Adjuster (required)
- Minimum 1 year of experience handling California claims (required)
- Additional experience in Arizona and Utah preferred
- Proficient written and verbal communication skills
- Awareness of task impact on team and deliverables
- Experience with G-Suite Tools and collaboration tools like Slack (preferred)
- Demonstrated knowledge and experience in claim adjudication and medical management
- Ability to analyze multiple data points and take necessary action across focus areas
- Ability to use conflict resolution skills to reach beneficial outcomes
- Ability to make claim decisions that mitigate exposure while achieving optimal outcomes
