About the job
At Pie Insurance, our mission is to empower small businesses to thrive by making commercial insurance affordable and straightforward. Utilizing advanced technology, we revolutionize the way small businesses purchase and experience commercial insurance.
We pride ourselves on a diverse team of innovators, visionaries, and entrepreneurs, guided by our core values and operating principles that inform every decision we make.
The Medical Only Claims Adjuster is pivotal in ensuring exceptional claim file management and delivering an industry-leading customer experience. This role involves strict adherence to Pie’s Claims Best Practices while complying with regulatory and statutory requirements. You will collaborate with both internal and external partners to achieve top-tier performance, pinpoint claim mitigation opportunities, and secure favorable outcomes for our customers.
Key Responsibilities
Claims Technical Management:
- Manage all aspects of workers’ compensation medical only claims from initiation to resolution independently.
- Conduct timely two-point contact investigations focusing on ongoing medical management, potential for lost time benefits, and adjusting claim closure as facts evolve.
- Minimize claim exposure while striving for optimal outcomes.
- Make prompt and accurate compensability decisions within statutory requirements.
- Set and adjust accurate reserves in line with company best practices and case facts.
- Administer statutory medical benefits promptly throughout the claim lifecycle.
- Utilize Utilization Review appropriately and ensure medical bills are paid within designated timeframes.
- Adhere to all relevant statutory guidelines, rules, and regulations.
- Proactively identify and assign claims for indemnity conversion when criteria are met.
- Ensure prompt resolution of medical treatments to expedite claim closure.
- Maintain a balanced inventory of lien resolution claims, negotiating towards suitable resolutions.
Claims Customer Service:
- Act as a primary contact for partner agents and customers, providing general claim guidance and managing expectations throughout the claim process.
- Assist as required in various claim-related inquiries and processes.