Claims Adjudication Specialist at Extend · LumiJobs

Responsibilities

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.
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.

Claims Adjudication Specialist

Responsibilities

Qualification

Preferred

Benefits

Company

Extend

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