Warranty Claims Adjudicator

Description

The Warranty Claims Adjudicator is responsible for evaluating and processing claims, ensuring accuracy, compliance, and exceptional customer service. This role involves investigating coverage, determining liability, negotiating settlements, and maintaining accurate claim records. The Adjudicator works to enhance the adjudication process, keep up to date with industry regulations, and coordinate repairs or replacements within the network.

Supervisory Responsibilities

This position does not have direct supervisory responsibilities but requires collaboration with various stakeholders, including customers, vendors, and internal teams.

Essential Functions

• Independently assess claims to determine coverage, liability, and fraud risks, using warranty terms, vehicle records, and policy documents while balancing the interests of customers, dealerships, technicians, and the company.
• Process claims efficiently, ensuring accuracy, compliance with legal and audit standards, and alignment with company policies and guidelines.
• Engage directly with customers, dealerships, and technicians to gather necessary claim information, providing clear, timely communication throughout the claims process.
• Maintain accurate, up-to-date claim records in Salesforce CRM, documenting all decisions, actions, and interactions to ensure transparency and accountability.
• Identify inefficiencies in the claims adjudication process and implement improvements to increase speed, accuracy, and overall customer satisfaction.
• Earn Trust by guiding junior claims representatives on best practices and complex claim resolution, helping them to build self-sufficiency and enhance their performance.
• Stay current with industry regulations and best practices to ensure all claims are processed in compliance with applicable legal and company standards.
• Conduct thorough investigations into claims, reviewing agreements, supporting documents, and other relevant information to validate the completeness and authenticity of each claim.
• Prepare comprehensive reports for management on complex or high-risk claims, clearly outlining findings, recommendations, and potential risks.
• Negotiate settlements for complex claims independently, ensuring fair and equitable outcomes that align with business objectives, while fostering positive relationships with all stakeholders.
• Be Responsive by providing transparent, clear communication to customers, dealerships, and stakeholders regarding claim decisions, ensuring clarity and mutual understanding.
• Assess and document damages through detailed inventories, photos, and damage scopes to ensure accurate evaluation and proper claims processing.
• Create competitive repair and replacement quotes using industry-standard tools, and coordinate repairs with the company network, ensuring costs remain within acceptable limits.
  
  

Non-essential Functions

• Participate in department meetings and assist with other claims-related tasks as required.
• Assist in training sessions, process improvement projects, and other assigned duties.
  
  

Requirements

• Strong ability to analyze complex claims, identify discrepancies, and resolve issues accurately and efficiently.
• Expertise in Microsoft Office, Salesforce, and claims management software for managing workflows and claim data.
• Excellent organizational and multitasking skills, ensuring accuracy and efficiency in a fast-paced environment.
• Personable and professional written and verbal communication for reporting, correspondence, and resolving complex claims issues.
• Experience maintaining confidentiality and adhering to data security standards in compliance with regulations.
• Competency in financial calculations and cost estimation for accurate claims evaluation.
• Proven ability to engage with diverse individuals and resolve claims-related matters while maintaining positive relationships.
• Focused on making informed decisions independently, aligning with policies and company objectives.
  
  

Physical Demands

• Regularly required to sit, talk, and hear.
• Ability to view a computer monitor and phone screen with clear vision at 20 inches or less.
• Noise level in the work environment is typically moderate.