Claims Adjudication Specialist

About the Role: 

As a Claims Adjudication Specialist, you will hold a pivotal position within our Operations Department specifically focusing on evaluating claims related to our Product and Shipping Protection plans offered by 1000+ of our Merchant Partners. Your primary responsibility will be to ensure accurate adjudication decisions of claims that require a more indepth evaluation. The role requires a complex understanding and ability to interpret multiple policies across dozens of product categories each with their own set of terms and conditions. On a day to day basis you will be required to perform detailed analysis of complex claims, handle escalations, and conduct investigations of unusual claim patterns. Success in this role demands meticulous attention to detail, critical thinking, robust analytical capabilities, and the ability to make evidence based decisions.

You will work closely with customers, our service partners and internal support teams to deliver efficient claim decisioning while providing outstanding Customer Experiences. This role requires inbound, outbound and email communication with customers, service providers, and internal stakeholders.

Responsibilities:

• Utilize your comprehensive understanding of applicable terms and conditions and knowledge and technology tools to accurately adjudicate Product and Shipping Protection claims. 
• Ensure adherence to established policies and guidelines while delivering exceptional Customer Experience with timely resolutions.
• Handle escalated claims requiring advanced analysis and resolution. 
• Engage with internal stakeholders and leadership to identify and provide insights to the root causes of escalations, process gaps, and technology opportunities.
• Conduct thorough investigations into suspected fraudulent activities associated with claims.

• Make recommendations for automating redundant tasks and creating efficiency and improvement opportunities. 

Preferred Experience, Skills, and Knowledge:

• 3-5 years of technical customer service, claims management/adjudication, insurance adjusting, or contact center experience. Claims adjudication preferably in a protection plan environment.
• 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.
• Active adjuster licenses preferred. 
• Experienced with claims management systems, contact center platforms and Google suites of products.
• Proven ability to 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.