Evaluate, process, and adjudicate warranty and service contract claims while ensuring accuracy, compliance, and exceptional customer service. Act as a liaison between the company, claimants, vendors, agents, and dealerships to communicate claim status and coverage decisions. Interpret contracts, manage claim resolutions, coordinate repairs or payments, and maintain accurate claim records. Build trusted relationships with internal and external partners, support business objectives, and contribute to continuous process improvement.

Essential Job Functions:

The Warranty Claims Adjudicator must be able to perform all the following duties and responsibilities with or without reasonable accommodation.

Claim Adjudication:

• Independently review warranty contracts to determine claim coverage, liability, and potential fraud risk; approve, authorize payment, or deny claims in accordance with policy terms and company guidelines.

• Process claims accurately and efficiently while ensuring compliance with legal, audit, and internal standards.

• Conduct thorough claim investigations by reviewing agreements, inspection reports, vehicle records, and supporting documentation to validate claim authenticity and completeness.

• Order and evaluate inspection reports as needed to support claim determinations.

• Engage directly with customers, dealerships, technicians, vendors, and internal teams via inbound and outbound calls and email to gather required information and provide clear, timely status updates.

• Assist customers and vendors with opening new claims, answering product and service inquiries, and providing updates on existing claims.

• Ensure all required documentation is obtained, audited, and properly attached to claims prior to processing; follow up proactively for missing information.

• Maintain accurate, up-to-date claim records in the claims management system, documenting all actions, decisions, and communications to ensure transparency and accountability.

• Manage claim queues effectively to meet service-level agreements, returning voicemails and responding to emails within required timeframes.

• Identify process inefficiencies and contribute to continuous improvement initiatives to enhance speed, accuracy, and customer satisfaction.

• Demonstrate sound judgment, problem-solving skills, integrity, and discretion when handling confidential information.

• React with appropriate urgency to high-priority or time-sensitive situations, taking effective action with minimal supervision.

• Work collaboratively across departments to communicate claim status and resolve issues efficiently.

• Work collaboratively in a team environment and build effective working relationships inside and outside of the group.

• Demonstrate sound judgment and problem-solving skills.

• Provide guidance and support to junior claims representatives on best practices and complex claim resolution, fostering development and self-sufficiency.

• Collaborate with dealerships to obtain accurate documentation for specialized claims and unregistered warranties to support proper claim adjudication, calculations, and settlements.

• Process vendor assignments, invoices, and settlement payments.

• Evaluate and make final determinations on transfer and renewal requests, including document review, customer communication, and approval or denial decisions.

• Prepare detailed reports for management on complex or high-risk claims, outlining findings, recommendations, and potential exposure.

• Perform additional duties as reasonably assigned.

• The minimum educational background of an applicant for this position is a high school degree or a GED. College preferred, although not required. Must have at least 2 – 3 years of warranty, claims, call center, and customer service experience.
• In addition, a qualified applicant will have:
• Strong ability to analyze complex claims, identify discrepancies, and resolve issues accurately and efficiently.
• Proficiency in Microsoft Office (Word, Excel, Outlook), and claims management systems to manage workflows and claim data effectively.
• Excellent organizational, time management, and multitasking skills with the ability to maintain accuracy in a fast-paced, high-volume environment.
• Strong verbal and written communication skills, with the ability to communicate professionally and effectively with customers, vendors, and all levels of the organization.
• Personable and professional approach to customer interactions, correspondence, reporting, and complex issue resolution.
• Demonstrated ability to maintain confidentiality and adhere to data security, privacy, and regulatory compliance standards.
• Competency in financial calculations, cost estimation, and data interpretation to support accurate claims evaluation.
• Proven ability to engage with diverse stakeholders and resolve claims-related matters while maintaining positive working relationships.
• Ability to make informed, independent decisions while aligning with company policies, procedures, and business objectives.
• Strong problem-solving skills with the ability to work under pressure and meet deadlines.
• Detail-oriented with the ability to gather, analyze, and interpret routine claims data accurately.
• Ability to work effectively both independently and collaboratively in a team environment.
• Adaptable to changing organizational priorities, operational needs, and business processes.
• Comfortable working in a fast-paced, high-volume call center environment.
• Automotive insurance claims adjudication experience preferred.
• Experience with Vehicle Service Contracts (VSC) preferred.
• Bilingual (Spanish) preferred.

Supervisory Responsibility:

• This position does not have any supervisory responsibilities.

Work Environment:

• The majority of job responsibilities are performed while seated indoors with little exposure to hazards. Some flex hours may be required (must be able to work nights and weekends on a non-routine basis).

Contacts:

• Interaction will occur with various departments, employees, management, and customers in the performance of the job duties as they relate to the Claims Specialist.