CA - Team Lead, Claims - Workers Compensation

The Claims Team Lead is responsible for leading a team of Adjusters and Specialists by monitoring their workloads, providing supervisory oversight for individual claim activities, and providing technical and jurisdictional direction on claims adjudication to ensure Pie is providing optimal claim outcomes and experiences for our clients.  Additionally, this role is responsible for performance management and development of direct reports. The Team Lead will report to and work directly with the Claims Manager to achieve team and departmental goals. The Team Lead will need to be able and pivot quickly in a fast growing company and department.

How You’ll Do It

Claims Technical Oversight:

• Review and approve claim denials, payments, settlements, trials, and reserve requests.
• Perform claim audits to ensure consistency and accuracy in statutory/regulatory compliance, internal procedures and guidelines, and quality expectations. 
• Ensure reserves are adequately set for the ultimate probable outcome of the claim 
• Perform regular leader reviews and provide feedback and recommendations for individual claims files. 

Operational Management:

• Resolve escalated agent, broker, policyholder complaints and/or concerns.
• Identify trends that could be problematic and take steps to develop processes to correct.
• Additional project assignments at manager's discretion.

People Management: 

• Develop & lead a team of adjusters by ensuring the quality, accuracy, and timely resolution of claims that may include high exposure/complex cases. Oversee of all claim activity.
• Promote department goals and objectives to the team of Adjusters and Specialists. 
• Monitor workflows, claims processes, claim metrics, claim triage and caseloads 
• Build and promote customer service excellence. 
• Hire and develop adjusters by identifying opportunities to grow and strengthen new skills. 

The Right Stuff

• 2+  years of adjusting claims at a senior level.
• California workers’ compensation claims experience is required. Additional experience in AZ, NM, NV, OR, or UT is a plus.
• Comprehensive knowledge of workers compensation in multiple states along with general insurance policy coverage and the state case Laws.
• Advanced communication (written, verbal and presentation) skills, to deliver complex information effectively and align people with the needs of the project/team.
• Advanced problem solving skills, to be able to manage complex situations with multiple layers, and resolve to solution anticipating needs now and into the future.
• Intermediate awareness of your own tasks, and how it impacts the team and deliverables
• Advanced leadership skills, focusing on the growth and development of direct reports. 
• G-Suite Tools, Collaboration tools, Microsoft Office suite.
• High School diploma or GED required, Bachelor's Degree preferred.

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.