Claims Adjudication Specialist

Accountabilities • Review, investigate, and resolve complex product and shipping protection claims in accordance with contractual terms, coverage policies, and internal guidelines.

• Act as a primary escalation point for outsourced service providers, customer support teams, and service technician partners, ensuring difficult cases receive timely and appropriate attention.

• Investigate claim processing delays, identify root causes, and coordinate solutions to improve resolution times and customer satisfaction.

• Coordinate service technician dispatches and parts ordering when necessary to facilitate efficient claim resolution.

• Handle escalated customer concerns by identifying fair, policy-compliant solutions and communicating decisions clearly through phone calls and written correspondence.

• Investigate potentially fraudulent claims, assess available evidence, document findings, and escalate suspicious activity when appropriate.

• Maintain accurate, detailed records of claim decisions, customer interactions, technical issues, and partner communications across internal systems.

• Collaborate with Product and Engineering teams to troubleshoot unresolved claim issues and communicate recurring technical problems.

• Monitor service workflows, policy updates, and product offerings to ensure consistent and informed decision-making.

• Identify opportunities to streamline workflows, automate repetitive tasks, and improve operational efficiency.

• Recognize training needs among frontline support teams and recommend improvements that strengthen service quality and claim-handling accuracy.

• Respond to claim inquiries within established service-level agreements (SLAs), balancing efficiency, accuracy, and customer satisfaction in a high-volume environment.

Requirements

• 3–5 years of experience in technical customer service, claims management, claims adjudication, insurance adjusting, or contact center operations, preferably in a product protection or extended warranty environment.

• An active adjuster license is preferred but not required.

• Strong analytical and critical-thinking skills, with the ability to interpret multiple policies, assess supporting evidence, investigate complex situations, and make consistent, well-reasoned decisions.

• Excellent written and verbal communication skills, including the ability to explain complex claim decisions clearly to customers, service partners, and internal stakeholders.

• Proven ability to manage escalations, resolve customer concerns, and exercise sound judgment while working within established policies and contractual requirements.

• Experience using claims management systems, contact center platforms, and Google Workspace or similar productivity tools.

• Ability to navigate multiple software applications simultaneously while maintaining accurate documentation and attention to detail.

• Strong organizational and time-management skills, with the ability to prioritize competing demands and meet response deadlines in a high-volume environment.

• Adaptability and resilience when responding to evolving processes, new technologies, changing priorities, and the demands of a growing business.

• A proactive, customer-focused mindset, with the ability to collaborate across teams, identify recurring issues, and recommend practical process improvements.

• Authorization to work in the United States without requiring employer-sponsored immigration support.

Benefits

• Annual salary: $45,000–$55,000, depending on experience, job-related skills, and work location.

• Healthcare coverage: Medical, dental, and vision benefits.

• Equity opportunity: Stock in a growing, early-stage technology company.

• Flexible paid time off: A generous PTO policy designed to support work-life balance.

• Retirement benefits: 401(k) plan with financial guidance from Morgan Stanley.

• Collaborative environment: Work alongside a supportive, diverse team in a fast-growing organization.

• Career development: Opportunities to build expertise in claims adjudication, customer operations, fraud investigation, and technology-enabled service delivery.

• Remote work: A remote position for eligible candidates based in the United States.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1