Role Description Looking for someone with wage loss experience in the states of IL/MI/IN. This position has the ability to work remotely. Under general supervision and following standard procedures with independent judgment, investigates, evaluates and resolves/disposes of workers compensation claims to determine the extent of company liability; may include determination and evaluation of coverage, compensability, and liability in accordance with policy provisions by performing the following duties: - Follows corporate policies, procedures, and fair claims handling practices. - Investigates claims to determine validity and extent of liability, including: - Obtains information necessary to properly investigate and evaluate each case by corresponding with agents, insureds, claimants, witnesses and others. - Reviews and evaluates documentation, including applications, reports, and statements. - Monitors appropriate claim outcomes through self-audit process. - Delivers superior customer service to policyholders and agents, ensuring appropriate and timely resolution of claims service issues. - Ensures legal, regulatory and fair claims handling compliance. - Sets or recommends reserves based on results of claim investigation. - Within defined authority, manages, evaluates and concludes claims. Prepares and maintains claim reports. - May provide extensive interaction with insureds, agents, claimants, attorneys, and other service providers, including: - Conducts in-depth interviews and/or scene inspections. - Attends settlement conferences and/or trials. - May serve as a member of project teams, contributing to the achievement of project objectives. - Performs other duties as assigned. Qualifications - To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. - The requirements listed below are representative of the knowledge, skill, and/or ability required. - Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - Education/Experience: - Level 4: Two to four years related experience and/or training; or associate's degree (A.A.) from two-year college/technical school; or equivalent combination of education and related experience/training. - A minimum requirement for this position is the ability to work legally in the United States. No visa sponsorship/support is available for this position, including for any type of U.S. permanent residency (green card) process.

Manage property claims end-to-end with empathy, providing support and advice. Negotiate settlement options and ensure compliance through accurate documentation while participating in training to enhance team capabilities.

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, 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. The Complex Claims Adjuster will play a critical role in delivering quality claim file management and an industry-leading customer claims experience, by providing hands-on adjudication of catastrophic and large loss claims. This will be completed by adhering to Pie’s Claims Best Practices, complying with regulatory and statutory requirements, and applying advanced knowledge and experience with complex negotiation strategies, structured settlements, Medicare Set-Aside requirements, and overall risk evaluation and mitigation. This role will work with internal and external partners to deliver best in class performance, identify and pursue claim mitigation opportunities and deliver favorable claim outcomes for Pie’s customers. Additionally, the Complex Claims Adjuster will collaborate with the Complex Claims Practices Consultant and Claims leadership to continually seek out ways in which to improve claims processes and protocols. How You’ll Do ItClaims Technical Management: - 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. Claims Customer Service: - 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. Claims Resolution Management: - 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. Collaboration & Innovation - 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. The Right Stuff - High School Diploma or equivalent is required. - Bachelor's Degree or equivalent experience with some college coursework is preferred. - Minimum of 7 years workers’ compensation claim adjusting experience is required (carrier background, preferred). - 2+ years of catastrophic claim handling experience. - Ability to evaluate and identify high dollar, high exposure, complex claims. - Strong claims handling experience within the Southeast region preferred, with expertise in Florida, Georgia, and/or North Carolina. Candidates should demonstrate a willingness to expand their jurisdictional knowledge and obtain additional state licenses as business needs evolve. - Requires active licensing in applicable states. - 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. - Ability to mentor junior adjusters. The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process. Base Compensation Range $95,000—$120,000 USD Compensation & 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 - Our core values are more than just a poster on the wall; they’re tangibly reflected in our work Making every part of working with us "Easy as Pie" - including our offer process. When we find someone we'd like as a Pie-oneer (a member of our team), we move quickly to put together a fair offer based on your skills, experience, location, and compensation expectations. Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members. Location Information Unless otherwise specified, this role is remote. Remote team members must live and work in the United States (territories excluded) and have access to reliable, high-speed internet. Additional InformationPie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic. Pie Insurance participates in the E-Verify program. Please click here, here and here for more information. Pie Insurance is committed to protecting your personal data. Please review our Privacy Policy. Safety First: Pie Insurance is committed to your security during the recruitment process. We will never ask you for credit card information or ask you to purchase any equipment during our interview or onboarding process. Pie Named to 2025 America's Best Startup Employers Pie Insurance 2025 State of Workplace Safety Report #LI-REMOTE #BI-REMOTE

• Investigate, evaluate, and adjust a variety of property and casualty claims • Negotiate effectively and professionally with claimants, public adjusters, legal counsel, and third-party representatives • Process payments, issue settlements within designated authority limits, and maintain precise claim records • Provide technical expertise and support for high-value, complex, or multi-faceted claims • Adhere to company policies, guidelines, state insurance regulations, and industry best practices • Perform full desk-based adjusting, leveraging modern technology, digital documentation, and remote evaluation tools.