Product Protection Done Right
Claims Adjudication Specialist – Tier I
Location
United States
Posted
2 days ago
Salary
$45K - $55K / year
Seniority
Senior
Job Description
Claims Adjudication Specialist – Tier I
Extend
• Serve as the escalation point of contact from outsourced partners, customer support teams and service technician partners. • Investigate and resolve complex claim situations, ensuring decisions align with contract terms and internal policies. • Troubleshoot delays in claims processing, ensuring timely resolutions and enhanced customer satisfaction. • Coordinate service technician dispatching and parts ordering when necessary to support claim resolution. • Resolve escalated customer issues by proposing fair resolutions within policy guidelines and clearly communicating outcomes to the customer. • Maintain detailed and organized documentation of all customer and partner interactions. • Investigate suspected fraudulent claims and report findings as needed. • Recommend process improvements and opportunities to automate routine tasks. • Provide timely responses to claim inquiries via phone and email, in line with established SLAs. • Collaborate with Product and Engineering teams to troubleshoot and escalate unresolved claim issues. • Stay up to date on product offerings, service workflows, and policy updates to better support customers. • Identify and communicate training needs for front-line support teams to improve service quality. • Keep internal systems current with relevant technical issues, customer feedback, and insights.
Job Requirements
- 3-5 years of technical customer service, claims management/adjudication, insurance adjusting, or contact center experience. Claims adjudication preferably in a protection plan environment.
- Active adjuster licenses (preferred).
- Excellent communication skills, both verbal and written with the ability to convey complex claim details and supporting rationale for decisioning in a clear and concise way both to customers and internal system notations.
- Embraces frequent change in processes and technology within a fast-paced environment, demonstrating flexibility and resilience in managing evolving challenges.
- Experienced with claims management systems, contact center platforms, and Google suites of products.
- Proven ability to navigate and work effectively across various software systems simultaneously.
- Ability to analyze complex issues, identify solutions, and make decisions efficiently.
- Thrive in environments of high claim volumes with exponential company growth while maintaining excellent performance and accuracy.
Benefits
- Competitive salary based on experience, with full medical and dental & vision benefits.
- Stock in an early-stage startup growing quickly.
- Generous, flexible paid time off policy.
- 401(k) with Financial Guidance from Morgan Stanley.
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