Position Title: Claims Specialist
Reports To: Claims Supervisor
Department: Claims Department
Status: Non-Exempt
Position Purpose:
Responsible for coordinating and supporting initiatives relative to the evaluation, processing, and handling of claims. Acts as a liaison between CalTex, claimants, vendors, agents and dealerships regarding the status and eligibility for coverage for all relevant claims. Responsible for the claim adjudication process that includes the interpretation of warranty and service contracts, rendering coverage decisions, managing claim resolutions/issues and ensuring work and payments are completed successfully.
Essential Job Functions: The Claims Specialist must be able to perform all of the following duties and responsibilities with or without a reasonable accommodation.
Claims Processing:
- Review warranties to determine coverage of claim, and approve, authorize payment or deny accordingly.
- Responsible for high quality customer interactions via inbound and outbound calls.
- Order and review inspection reports when needed to assist in making claims determination.
- Make sure all documents are attached to the claim prior to submitting for processing.
- Work with dealerships to ensure the proper paper work is received for calculations on theft product claims.
- Process vendor assignments to ensure payments are sent correctly.
- Assist consumers in obtaining the necessary documentation from the dealership to get warranty registered and submitted for claim processing.
- Interact with customers, vendors and internal staff via inbound/outbound calls and email.
- Answer general questions on products and services.
- Return voicemail and reply to emails within required service levels.
- Assist customers and vendors with opening a new claim and giving status on existing claims.
- Maintain work queue to ensure claims are processed timely and effectively making follow up calls as needed for missing documents.
- Make determination on transfer/renewal requests, communicate with customers on needed documents, audit documents for the request and make final approval/denial decision.
- Process invoices and submit settlement payments.
- Process, communicate and mail checks for paid claims.
- Work with various departments to receive and communicate the status of warranty claims.
- Manage time effectively, complete tasks and projects quickly with little to no guidance, think and plan ahead.
- React with appropriate urgency to situations that require a quick turnaround, and take effective action without having to know the total picture.
- Possess and exhibit an exemplary level of integrity and discretion in handling confidential information.
- Maintain a strong focus on continuous process improvement.
- Work collaboratively in a team environment and build effective working relationships inside and outside of the group.
- Demonstrate sound judgment and problem-solving skills.
- Perform other duties that may reasonably be assigned.
Education/Experience:
The minimum educational background of an applicant to this position is a High school degree or GED required. 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:
- Automotive insurance claims adjudication experience-preferred.
- Experience with Vehicle Service Contracts (VSC)-preferred.
- Strong verbal and written communication skills with the ability to communicate effectively with others at all levels of the organization.
- Good problem solving and time management skills.
- Ability to work in a team environment and engage with peers and management as well as working independently.
- Strong organizational skills and the ability to multi task while producing quality results.
- Ability to adapt to changing organizational and operational needs.
- Must be comfortable working in a fast-paced, high-volume call center.
- Detail oriented, can work under the pressure of deadlines and multi-task.
- Some analytical ability required to gather and interpret data where activities are routine in nature.
- Basic knowledge of Word, Excel, and Outlook databased related applications as well as phone and claims management systems.
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 and management, and customers in the performance of the job duties as they relate to the Claims Specialist.