Senior Claims Adjuster, Workers Compensation (California)

As a Senior Claims Adjuster at Pie Insurance, your primary responsibilities include managing all facets of workers’ compensation claims from initiation to closure. You'll evaluate and handle complex claims, conduct thorough 3-point investigations, and make timely compensability decisions. This role also requires setting reserves, controlling legal activity, and negotiating settlements while ensuring compliance with statutory regulations.

The Senior Claims Adjuster position at Pie Insurance generally requires a high school diploma or equivalent, and a bachelor’s degree or relevant experience is preferred. A minimum of five years of claims adjusting experience in workers' compensation is essential, with a focus on California claims preferred. Candidates should possess strong problem-solving abilities, excellent communication skills, and hold active licensing in applicable states.

At Pie Insurance, we are committed to fostering a culture of continuous improvement. Senior Claims Adjusters have opportunities not only to manage complex claims but also to mentor junior adjusters, enhancing their skills and knowledge. We encourage regular feedback and provide resources for professional growth to ensure our team members evolve with the industry's best practices.

The work environment at Pie Insurance is flexible and supportive. The Senior Claims Adjuster position allows for hybrid or remote work options, providing team members with the freedom to balance their professional and personal lives. Our culture emphasizes collaboration, innovation, and mutual respect while ensuring that everyone feels valued and part of the team.

Senior Claims Adjusters at Pie Insurance are offered a competitive compensation package that includes a base salary ranging from $80,000 to $100,000, comprehensive healthcare plans, generous PTO, and a robust 401k match program. Additionally, employees participate in equity options, encouraging a sense of ownership and teamwork within the organization.

When addressing complex claims, my approach begins with thorough investigation and communication. I prioritize gathering all necessary facts and engaging stakeholders to ensure we’re on the same page. I then evaluate the claim's exposure, make informed decisions on compensability, and plan the most effective strategy to mitigate risks while seeking favorable outcomes.

I have considerable experience navigating California workers’ compensation laws gained through my previous roles. I've worked on multiple claims that required a deep understanding of statutory guidelines, and I'm adept at making timely, compliant decisions that align with the state’s regulations. Staying updated on regulatory changes is a priority for me.

In situations where disagreements arise with legal counsel, I believe in fostering open communication. I prefer to approach these discussions collaboratively, presenting all evidence and perspectives. The goal is to address concerns directly and seek common ground that prioritizes the best outcome for the customer while managing legal fees effectively.

I once mentored a junior adjuster who was struggling with case evaluations. I spent time demonstrating my thought process, how to approach claims analytically, and encouraged them to ask questions freely. Over time, they gained confidence in making independent decisions. Seeing their growth was rewarding and reinforced my belief in the importance of mentorship in our field.

My strategies for ensuring timely claim resolution involve setting clear timelines and expectations from the onset. I utilize a proactive approach, engaging with all parties throughout the claims process to avoid roadblocks. I prioritize continuous communication with stakeholders and regular follow-ups to keep the momentum going until resolution.

I once managed a high exposure claim involving a major injury. I coordinated with medical professionals, legal counsels, and the claimant to gather comprehensive information. By efficiently updating reserves and negotiating with involved parties, I was able to reach a favorable settlement that minimized exposure while ensuring the claimant received the necessary support.

Ensuring compliance begins with a strong understanding of statutory requirements and continuous education on changes in laws and regulations. I keep detailed records of all actions taken during the claims process and regularly review these steps to ensure alignment with legal standards. Audit trails and checklists help me maintain compliance consistently.

Communication is vital throughout the claims adjusting process. I make it a point to keep all stakeholders informed, ensuring they understand the claims process and can provide any needed information promptly. By fostering transparency and addressing concerns early, I aim to build trust and cooperation, which is crucial for effective claim management.

When prioritizing multiple claims, I assess them based on urgency and complexity. I categorize them to determine which require immediate attention and which can be resolved with more time, allowing me to allocate resources efficiently. Regularly revisiting priorities helps ensure all claims are progressing appropriately.

I am enthusiastic about the opportunity to work at Pie Insurance because of its commitment to innovation in the insurance space. I admire how the company values its employees and promotes a positive culture that aligns with my own beliefs. Contributing to a mission that empowers small businesses deeply resonates with me, and I am eager to bring my skills to the team.