Claims Adjudication Specialist

About the company

The organization operates in the retail technology industry, addressing challenges in the post-purchase experience for merchants and their customers. It provides AI-driven solutions that improve customer satisfaction and help businesses increase revenue. Their platform includes automated customer service, returns and exchange management, automated fulfillment, product and shipping protection, and fraud detection. The organization partners with over 1,000 merchants across diverse industries such as fashion, cosmetics, furniture, electronics, and more.

About the role

The Claims Adjudication Specialist is responsible for evaluating and servicing claims related to product and shipping protection plans offered through the organization's merchant partners. This role serves as a subject matter expert, supporting customer support and service technician teams to ensure accurate and timely resolution of complex claims. The specialist handles escalations, investigates unusual claim patterns, and collaborates with various stakeholders to deliver precise claim decisions and maintain a high-quality customer experience.

Responsibilities

• Act as the escalation contact for outsourced partners, customer support, and service technicians.
• Investigate and resolve complex claims aligning with contract terms and policies.
• Address delays in claims processing to ensure timely resolution.
• Coordinate service technician dispatch and parts ordering as needed.
• Resolve escalated customer issues by proposing fair outcomes within policy guidelines.
• Maintain detailed documentation of all interactions.
• Investigate and report suspected fraudulent claims.
• Recommend process improvements and automation opportunities.
• Respond to claim inquiries via phone and email within established service levels.
• Collaborate with Product and Engineering teams to troubleshoot unresolved claim issues.
• Stay current on product offerings, workflows, and policy updates.
• Identify training needs for front-line support teams.
• Update internal systems with technical issues and customer insights.

Requirements

• Preferably hold active adjuster licenses.
• 3 to 5 years of experience in technical customer service, claims management/adjudication, insurance adjusting, or contact center roles; experience with protection plan claims adjudication preferred.
• Strong verbal and written communication skills to convey complex claim decisions clearly.
• Ability to adapt to frequent changes in processes and technology in a fast-paced environment.
• Experience with claims management systems, contact center platforms, and Google Suite.
• Proficiency in using multiple software systems simultaneously.
• Analytical skills to identify solutions and make efficient decisions.
• Ability to maintain accuracy and performance in high-volume, fast-growing environments.

Pay

Estimated annual salary range: $45,000 to $55,000, dependent on factors including location and experience.

Benefits

• Medical, dental, and vision insurance.
• 401(k) plan with financial guidance.
• Flexible paid time off policy.
• Stock options in a growing early-stage startup.