Pie Insurance · 4 weeks ago
Medical Only Claims Adjuster - California
United States
Full-time
Remote
Entry Level
$60K/yr - $75K/yr
1+ years expPie Insurance is dedicated to empowering small businesses by making commercial insurance affordable and accessible. The Medical Only Claims Adjuster will manage workers’ compensation claims, ensuring compliance with best practices and delivering exceptional customer service throughout the claims process.
Financial ServicesInsuranceInsurTechSmall and Medium Businesses
Responsibilities
Independently handle all aspects of the workers’ compensation medical only claims from set-up to closure
Conduct timely 2-point contact investigation, with focus on continued medical management, potential for lost time benefits, and claim closure as facts of the case change
Mitigate claim 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
Timely administration of statutory medical benefits throughout the life of the claim
Use Utilization Review where appropriate and pay medical bills within the allotted timeframes
Comply with all applicable statutory guidelines, rules, and regulations
Proactively identify and timely assign claims that meet indemnity claim conversion criteria
Consistent and timely resolution of medical treatment to resolve and close claims
Maintain a split inventory of Lien resolution claims, negotiating liens to appropriate resolution
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 1-years workers' compensation claims experience as a medical only adjuster is required
Proficient communication (written and verbal) skills, to deliver information effectively
Awareness of your own tasks, and how it impacts the team and deliverables
Demonstrated knowledge and experience in claim adjudication and medical management
Developing ability to analyze and take necessary action in multiple focus areas, based on several data points
Ability to use skills to overcome conflict and reach beneficial outcomes
Ability to make claim decisions to mitigate exposure while achieving the best outcome
Preferred
Bachelor's Degree or equivalent experience with some college coursework
Experience in the following states preferred due to higher volume: CA, AZ, UT and TX
Experience using G-Suite Tools, and collaboration tools like Slack
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
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
The Philadelphia Inquirer
2025-08-13
Company data provided by crunchbase