Claims Adjuster, Workers Compensation

<div class="content-intro"><div>Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance.</div> <div> <div> </div> <div>Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by <a class="postings-link" href="https://pieinsurance.com/culture">core values and operating principles</a> that guide every decision we make.</div> </div></div><p>The Claims Adjuster will play a vital role in delivering quality claim file management and an industry-leading customer claims experience. This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers. </p> <h3><strong>How You’ll Do It</strong></h3> <p><strong>Claims Technical Management:</strong></p> <ul> <li>Independently handle all aspects of the workers’ compensation claims from set-up to closure.</li> <li>Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change.</li> <li>Mitigate claim  exposure while achieving the best outcome.</li> <li>Determine timely and accurate compensability decisions within statutory requirements.</li> <li>Set and adjust timely/accurate reserves within authority limits to ensure reserving activities are consistent with the case facts and company best practices.</li> <li>Timely administration of statutory medical and indemnity benefits throughout the life of the claim.</li> <li>Comply with all applicable statutory guidelines, rules, and regulations.</li> <li>Control legal activity with defense counsel through the litigation process while managing legal fees and costs.</li> <li>Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement.</li> </ul> <p><strong>Claims Customer Service:</strong></p> <ul> <li>Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations.</li> <li>Assist as necessary in providing claim status to agents and insureds, coverage verification and loss run reports, etc.</li> <li>Provide excellent customer service to internal and external customers and business partners. </li> <li>Participate in interactions with TPA adjusters and claims partners to drive optimized claims outcomes and top-notch claims experience.</li> <li>Advocate to ensure that Pie has a leading claims customer experience.</li> <li>Work to continuously improve our claims operations and look at opportunities and gaps in claim service, handling SOPs, protocols and processes. </li> </ul> <h3><strong>The Right Stuff</strong></h3> <ul> <li>High School Diploma or equivalent is required.</li> <li>Bachelor's Degree or equivalent experience with some college coursework is preferred.</li> <li>Minimum of 2-years workers’ compensation claims experience is required.  </li> <li>Claims experience working in at least two of these states is preferred: Alabama, Arkansas, Colorado, Connecticut, Delaware, DC, Indiana, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Nebraska, New Hampshire, Rhode Island, Vermont, West Virginia, Wisconsin. </li> <li>Strong communication (written and verbal) skills, to deliver more complex information effectively.</li> <li>Strong  problem solving skills to be able to manage complex tasks and work through to solutions with little guidance and direction.</li> <li>Awareness of your own tasks, and how it impacts the team and deliverables.</li> <li>Experience using G-Suite Tools, and collaboration tools like Slack is preferred.</li> <li>Knowledge of jurisdictional regulatory and statutory requirements and CMS/MSA requirements.</li> <li>Demonstrated knowledge and experience in claim adjudication, medical management and litigation management.</li> <li>Developing ability to analyze and take necessary action in multiple focus areas, based on several data points.</li> <li>Ability to use skills to overcome conflict and reach beneficial outcomes.</li> <li>Ability to make claim decisions to mitigate exposure while achieving the best outcome</li> </ul> <p><strong>The use of AI in Application Review:</strong> To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process.</p><div class="content-pay-transparency"><div class="pay-input"><div class="title">Base Compensation Range</div><div class="pay-range"><span>$70,000</span><span class="divider">—</span><span>$90,000 USD</span></div></div></div><div class="content-conclusion"><h3><strong>Compensation & Benefits </strong></h3> <ul> <li style="font-weight: 400;"><span style="font-weight: 400;">Competitive cash compensation</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">A piece of the pie (in the form of equity)</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Comprehensive health plans</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Generous PTO</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Future focused 401k match</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Generous parental and caregiver leave</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">Our </span><a href="https://pieinsurance.com/culture/"><span style="font-weight: 400;">core values</span></a><span style="font-weight: 400;"> are more than just a poster on the wall; they’re tangibly reflected in our work </span></li> </ul> <p><strong>Our goal is to make all aspects of working with us as easy as pie. </strong><span style="font-weight: 400;">That includes our offer process. When we’ve identified a talented individual who we’d like to be a Pie-oneer , we work hard to present an equitable and fair offer. We look at the candidate’s knowledge, skills, and experience, along with their compensation expectations and align that with our company equity processes to determine our offer ranges. </span></p> <p><span style="font-weight: 400;">Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members.</span></p> <h3><strong>Location Information </strong></h3> <p>Unless otherwise specified, this role is remote. Remote team members must live and work in the United States (<em data-start="218" data-end="240" data-is-only-node="">territories excluded</em>) and have access to reliable, high-speed internet.</p> <h3><strong>Additional Information</strong></h3> <p><em><span style="font-weight: 400;">Pie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic.</span></em></p> <p><em><span style="font-weight: 400;">Pie Insurance participates in the E-Verify program. Please click </span></em><a href="https://www.e-verify.gov/sites/default/files/everify/posters/EVerifyParticipationPoster.pdf"><em><span style="font-weight: 400;">here</span></em></a><em><span style="font-weight: 400;">, </span></em><a href="https://www.justice.gov/crt/case-document/file/1133936/download"><em><span style="font-weight: 400;">here</span></em></a><em><span style="font-weight: 400;"> and </span></em><a href="https://www.justice.gov/crt/case-document/file/1133941/download"><em><span style="font-weight: 400;">here</span></em></a><em><span style="font-weight: 400;"> for more information.</span></em></p> <p><span style="font-weight: 400;">Pie Insurance is committed to protecting your personal data. Please review our <a href="https://pieinsurance.com/privacy/" target="_blank">Privacy Policy</a>.  </span></p> <p><span style="font-weight: 400;">Safety First: Pie Insurance is committed to your security during the recruitment process. We will never ask you for credit card information or ask you to purchase any equipment during our interview or onboarding process.</span></p> <p><span style="font-weight: 400;"><a href="https://www.forbes.com/lists/americas-best-startup-employers/">Pie Named to 2025 America's Best Startup Employers</a></span></p> <p style="line-height: 1;"><a href="https://www.pieinsurance.com/resource-center/press/2025-state-of-workplace-safety-report">Pie Insurance 2025 State of Workplace Safety Report</a></p> <p style="line-height: 1;"> </p> <div> <div>#LI-REMOTE</div> <div>#BI-REMOTE</div> </div></div>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

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4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

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5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

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Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...