Licensed Claims Adjuster

About The Role

We are seeking a Licensed Claims Adjuster who will be responsible for adjudicating regulated insurance claims within the Digital Commerce vertical. This role sits at the intersection of regulatory compliance, policy interpretation, and operational performance.

Key Responsibilities

• Manage end-to-end handling of regulated insurance claims, including investigation, coverage analysis, formal determination, claim actions, communications, and payment issuance related to retail, electronics, appliances, and furniture within defined service-level agreements (SLAs).
• Interpret policy language and underwriting guidelines to issue compliant, well-reasoned coverage decisions in accordance with applicable state insurance regulations.
• Handle high-exposure, sensitive, or escalated claims requiring licensed authority and independent judgment.
• Maintain active state licensure and ensure adherence to jurisdictional insurance laws, DOI requirements, and internal governance standards.
• Identify potential fraud indicators and escalate appropriately in line with company protocols and fraud thresholds.
• Respond to customer inquiries via phone, email, or chat regarding claim status, documentation, and coverage decisions, communicating complex determinations clearly and professionally.
• Ensure all required documentation is collected, reviewed, and accurately recorded in the claims system to support audit integrity and regulatory compliance.
• Maintain high levels of claim accuracy and timeliness in alignment with business, team, and individual performance metrics.
• Provide guidance to non-licensed assessors on policy interpretation and complex files; collaborate with Claims, Support, and Compliance teams to ensure efficient and consistent resolution.
• Identify and recommend operational improvements to enhance efficiency, reduce leakage, and strengthen internal controls within the Digital Commerce vertical.

Skills & Experience

• Active U.S. state Adjuster License in good standing (multi-state or reciprocal licenses preferred).
• 2+ years of experience handling regulated insurance claims, ideally across electronics, appliances, or furniture, financial/credit card/NAC programs a plus.
• Strong knowledge of digital commerce and retail supply chain operations, including warranty and service contract programs.
• Familiarity with repair networks and ability to coordinate repair assessments and turnaround processes.
• Solid understanding of jurisdictional insurance regulations and fair claims handling practices.
• Strong analytical and investigative skills with sound judgment in evaluating documentation and determining coverage.
• Excellent written communication skills, particularly in drafting clear, defensible claim determinations.
• Experience working in a KPI-driven environment with accountability for quality and turnaround time.
• Ability to operate independently in a fully remote environment with strong organizational and time-management skills.
• Proficiency in claims management systems and digital documentation platforms.
• Collaborative mindset with the ability to provide technical guidance and support to junior or non-licensed team members.
• Bachelor's degree in a relevant field, A postgraduate degree and/or record of academic achievement is also desirable.