Auto Claims Adjuster I

This job is responsible for determining covered failures by reviewing vehicle service agreements, determining the need for inspection, interpreting policy coverage, and researching all facts, for multiple product lines; including but not limited to automobiles, recreational vehicles and power sports. This position requires direct interaction with customers and repair facilities with occasional contact directly with the client. Provide claim adjudication and problem resolution in the VPS Contact Center 90%

1. Responds to and resolves issues encountered by clients and customers in a timely and positive manner. This involves mostly inbound calls, but may also include outbound calls, email, fax and chat
2. Ensures that all customer/client requests are responded to in a timely manner, and meaningful solutions are proposed and implemented
3. Adheres to standards for effective job performance and development
4. Gains and maintains in-depth understanding of VPS products, clients, systems and applications
5. Ensures compliance with ISO, SOX, PCI and other applicable internal and external audits and/or contractual obligations
6. Adjust and document all claims within departmental standards and in accordance to applicable laws and policy provisions to ensure compliance with all Department of Insurance Regulations
7. Process claims with accuracy to confirm coverage by reviewing all available tools including contract and web based applications to resolve complex issues and refer any issues as necessary to senior level adjusters or supervisor
8. Adjudicate claims with accuracy, by working directly with the repair facility, inspection and parts vendors and multiple other resources to ensure proper claims adjudication within departmental standards
9. Document reasons for denial or authorization of claim in accordance with policy conditions and quoting policy language to the correct parties in a timely manner within authority level and seek approval when above authority

Process improvements and personal development 10%

1. Partakes in, and adheres to, training programs and quality assessment standards for effectiveness in supporting departmental goals and objectives
2. Actively participates in the development of personal performance management plans

Basic Qualifications

• High school diploma or GED
• 2 years of automotive technician or service advisor experience
• 2 years of computer experience using multiple windows applications

Other Requirements

• Excellent written and verbal skills to communicate with team members, management, customers, counselors and other employees of the organization
• Strong customer service skills
• Ability to work with frequent interruptions and under deadlines
• Ability to work collaboratively with others to generate ideas or resolve problems
• Ability to present a professional image
• Ability to establish courses of action to ensure efficient completion of work
• Ability to think creatively and make decisions based on incomplete information
• Ability to process time sensitive data and information from multiple sources, including data from mainframe systems, makes decisions based on this data, and to effectively communicate the related required actions to a broad audience
• Ability to quickly adapt to change, proactively recognize process improvement opportunities and be able to work independently as well as in a team setting
• Proficiency of computer navigation and Microsoft Office 2003 or later versions & Microsoft Windows XP or later versions
• Ability to pass licensing requirements within 18 months and maintain appropriate licenses

Environment/Physical Demands This position requires incumbents to regularly sit at a desk and operate standard office equipment such as a computer and phone. Employee is occasionally required to stand and walk, lift, carry and/or move up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Must be able to talk and hear. Required to use hands to finger, handle, or feel objects, tools or controls. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 0 % Travel