Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make.
Requirements
- Independently handle all aspects of catastrophic and large loss workers' compensation claims from set-up to closure.
- Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change.
- Determine timely and accurate compensability decisions within statutory requirements.
- Set and adjust timely/accurate reserves within authority limits to ensure reserving activities are consistent with the case facts and company best practices.
- Ability to present claims to senior management, internal and external stakeholders.
- Timely administration of statutory medical and indemnity benefits throughout the life of the claim.
- Comply with all applicable statutory guidelines, rules, and regulations.
- Control legal activity with defense counsel through the litigation process while managing legal fees and costs.
- Prioritize early resolution opportunities, evaluate claim exposure and negotiate settlement.
- Mitigate the complex exposure while achieving the best outcome.
- Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations.
- Provide claim status to agents and insureds, coverage verification and loss run reports, etc as necessary.
- Provide excellent customer service to internal/external customers and business partners.
- Work to continuously improve our claims operations and address opportunities and gaps in claim service, handling SOPs, protocols and processes.
- Direct a proactive litigation strategy to increase settlement opportunities.
- Assess claims for settlement value using rated ages, present value, medicare set asides, medical cost projections and structured settlements. Obtain settlement authority as required.
- Obtain annuity and structured settlement quotes.
- Attend virtual and in person mediations, informal settlement conferences and trials to represent Pie's interests.
- Participate in Claims Roundtable meetings. Develop a collaborative plan of action for aggressive claims handling.
- Create Claims Status Reports and establish timely, accurate reserves.
- Present large loss updates to internal and external partners.
- Collaborate with our Complex Claims Practices Consultant and Claims Leadership to continuously improve our claims operations and look at opportunities and gaps in claim service, handling SOPs, protocols and processes.
- Mentor junior adjusters.
- Advanced communication (written and verbal) skills, to deliver more complex information effectively.
- Advanced problem-solving skills to be able to manage complex tasks and work through to solutions with little guidance and direction.
- Awareness of your own tasks and how it impacts the team and deliverables.
- Experience using G-Suite Tools and collaboration tools like Slack is preferred.
- 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.
Benefits
- Competitive cash compensation
- A piece of the pie (in the form of equity)
- Comprehensive health plans
- Generous PTO
- Future focused 401k match
- Generous parental and caregiver leave
