Pie Insurance · 3 days ago
CA - Senior Claims Adjuster, Workers Compensation
United States
Full-time
Remote
Senior Level
$100K/yr - $125K/yr
5+ years expPie Insurance is dedicated to empowering small businesses by making commercial insurance affordable and accessible. The Senior Claims Adjuster will manage all aspects of workers' compensation claims, ensuring compliance with regulations while delivering exceptional customer service and improving claims operations.
Financial ServicesInsuranceInsurTechSmall and Medium Businesses
Responsibilities
Independently handle all aspects of the workers’ compensation claims from set-up to closure
Evaluate and handle high dollar, high exposure, complex claims
Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change
Mitigate the complex exposure while achieving the best outcome
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
Serve as a point of contact for our partner agents and customers to provide general claim guidance and help set claim process expectations
Assist as necessary in providing claim status to agents and insureds, coverage verification and loss run reports, etc
Provide excellent customer service to internal and external customers and business partners
Advocate to ensure that Pie has a leading claims customer experience
Work to continuously improve our claims operations and look at opportunities and gaps in claim service, handling SOPs, protocols and processes
Qualification
Required
High School Diploma or equivalent is required
Minimum of 5-years workers' compensation claim adjusting experience is required (carrier background, preferred)
Claims experience handling California WC claims is required
Requires active licensing in applicable states
Strong communication (written and verbal) skills, to deliver more complex information effectively
Strong 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
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
Ability to mentor junior adjusters
Preferred
Bachelor's Degree or equivalent experience with some college coursework is preferred
Experience using G-Suite Tools and collaboration tools like Slack is preferred
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
Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members.
Company
Pie Insurance
Pie Insurance is an insurance company specializing in small business.
201-500 employees
Funding
Current Stage
Late StageTotal Funding
$621MKey Investors
Gallatin Point CapitalSVB CapitalGreycroft
2022-09-21Series D· $315M
2021-03-25Series C· $118M
2020-05-28Series B· $127M
Leadership Team
John Swigart
Co-Founder and CEO
Audra Foglietta
Chief Financial Officer
Recent News
Hartford Business Journal
2025-08-14
Company data provided by crunchbase