Complex Claims Adjuster

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 Senior Claims Adjuster will play a critical role in delivering quality claim file management and an industry-leading customer claims experience., This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. 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.. How You’ll Do It Claims Technical Management: Independently handle all aspects of the workers’ compensation claims from set-up to closure. Evaluate and handle high dollar, high exposure, complex claims. Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change. Mitigate the complex 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. 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 settleme

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 Senior Claims Adjuster will play a critical role in delivering quality claim file management and an industry-leading customer claims experience., This will be completed by adhering to Pie’s Claims Best Practices and complying with regulatory and statutory requirements. 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. How You’ll Do It Claims Technical Management: Independently handle all aspects of the workers’ compensation claims from set-up to closure. Evaluate and handle high dollar, high exposure, complex claims. Conduct timely 3-point contact investigation, with focus on continued investigation as facts of the case change. Mitigate the complex 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. 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 settlemen

Airbnb was born in 2007 when two hosts welcomed three guests to their San Francisco home, and has since grown to over 5 million hosts who have welcomed over 2 billion guest arrivals in almost every country across the globe. Every day, hosts offer unique stays and experiences that make it possible for guests to connect with communities in a more authentic way. The Community You Will Join: The AirCover team is charged with ideating, building, launching, and managing the AirCover business inside of Airbnb. We have a huge responsibility to our community of Hosts and guests to be there when things don’t go exactly as planned with their reservations. We have a lot of work to do in the coming years and we are looking for someone who will help us manage all of the things that need to be done to deliver best-in-class services to our community. The Difference You Will Make: As a Complex Claims Manager in the Complex Claims, you will play a vital role in safeguarding the integrity of our Aircover platform by effectively identifying, investigating, and managing the risk and mitigation strategies in resolution of Complex and Large Loss claims. You'll manage partners to influence prioritization, drive accountability, deliver improvements, and scale changes on claims which impact Airbnb. You'll work with internal and external partners to influence prioritization, drive accountability, and deliver improvements. You will work closely with cross-functional teams to manage emerging risks / threats while enabling business growth in various markets. Philosophy will be to identify intelligence / risk gaps and work with other internal risk management teams (such as Trust team, and Safety team), third party adjusters, our partners, Platform Product Management, Global Crisis Management, Community support, Policy, Privacy Legal teams to strengthen Airbnb’s platform. You will be reporting at Monthly, Quarterly and Annual Business Reviews for your area. Yo

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 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 cla

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Review and adjust SF (self-funded), FI (fully insured), Reinsurance, and/or RX claims; adjudicates complex, sensitive, and/or specialized claims in accordance with claim processing guidelines. Process provider refunds and returned checks. May handle customer service inquiries and problems. Perform adjustments across all dollar amount level on customer service platforms by using technical and claims processing expertise. Applies medical necessity guidelines, determine coverage, complete eligibility verification, identify discrepancies, and apply all cost containment measures to assist in the claim adjudication process. Performs claim re-work calculations. Follow through completion of claim overpayments, underpayments, and any other irregularities. Process complex non-routine Provider Refunds and Returned Checks. Review and interpret medical contract language using provider contracts to confirm whether a claim is overpaid to allocate refund checks. Handle telephone and written inquiries related to requests for pre-approvals/pre-authorizations, reconsiderations, or appeals. Ensures all compliance requirements are satisfied and that all payments are made following company practices and procedures. Review and handle relevant correspondences assigned to the team that may result in adj

Front Line Manager - Insurance - P&C Claims Ready to turn bold ideas into real-world impact? At Genpact, we don’t just adapt to change, we lead it. AI and digital innovation are transforming the way businesses work, and we’re at the forefront of it. Genpact’s AI Gigafactory , our industry-first accelerator, exemplifies how we scale advanced technology solutions to help global enterprises work smarter, grow faster, and transform at scale. Whether tackling complex challenges through large-scale models or agentic AI , our breakthrough solutions tackle companies’ most complex challenges. If you thrive in a fast-moving, innovation-driven environment, love building and deploying cutting-edge AI solutions, and want to push the boundaries of what’s possible, this is your moment. Genpact (NYSE: G) is an agentic and advanced technology solutions company. We leverage process intelligence and artificial intelligence to deliver measurable outcomes. With a strong partner ecosystem and decades of client trust, we provide innovative solutions that transform how businesses run. Powered by a team with an active learning mindset and client centricity at its core, we deliver lasting value for the world’s leading enterprises. Get to know us at genpact.com and on LinkedIn , YouTube , X , and Facebook . Job Description Responsibilities: ·