Claims Adjudication Specialist (Tier I)

About the Role:

As a Claims Adjudication Specialist, you will play a critical role within our Operations Department, focused on evaluating and servicing claims related to our Product and Shipping Protection plans, which are offered by over 1,000 Merchant Partners. You’ll serve as a subject matter expert, supporting our Customer Support and Service Technician partners to ensure accurate and timely service of complex claims that require deeper investigation.

This position requires strong analytical skills, critical thinking, and the ability to interpret multiple policies across a wide range of product categories. On a daily basis, you’ll review complex claim submissions, manage escalations, and investigate unusual claim patterns. Success in this role relies on meticulous attention to detail, evidence-based decision-making and ability to adapt to frequent change in processes and technology within a fast-paced environment.

You'll collaborate closely with customers, service partners, and internal teams to deliver accurate claim decisions while ensuring an exceptional customer experience. The role involves inbound and outbound calls, as well as written communications with customers, service providers, and internal stakeholders. 

Responsibilities:

• Serves 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.

Preferred Experience, Skills, and Knowledge:

• Active adjuster licenses (preferred).
• 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.
• 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.

Estimated Pay Range: $45,000 - $55,000 per year salaried*

*The target base salary range for this position is listed above. Individual salaries are determined based on a number of factors including, but not limited to, work location and job-related knowledge, skills and experience.