Claims Resolution Specialist

4 days ago

Work from Home, Philippines Your Virtual Adjuster Full time ₱144,000 - ₱600,000 per year

Job Title: Resolution Specialist

Reports to: Claims ManagerLocation: RemoteJob Type: Full-Time

Position Overview

The Resolution Specialist will work directly with our Public Adjusters, and insurance carriers to maximize insurance claim payouts by identifying, documenting, and advocating for supplement items. You will play a key role in preparing and submitting supplements, following up with insurance companies, and facilitating resolutions to ensure fair settlements. Your contributions will directly influence our success, efficiency, and client satisfaction.

Key Responsibilities

  • File Review and Preparation
  • Thoroughly review insurance claims, estimates, and supporting documentation to identify potential supplements.
  • Ensure all claim details are accurate and in compliance with insurance carrier guidelines.
  • Documentation
  • Work with our intake & claims team to prepare and submit complete and detailed supplement packages, including analysis of line-item estimates, photographs, and other required documentation.
  • Maintain accurate records of claim progress and communication within our CRM systems.
  • Insurance Company Engagement
  • Contact insurance carriers to present claim differences to obtain payment for supplemental items.
  • Provide clear and compelling explanations of supplement requests to adjusters and claims representatives.
  • Follow up persistently to resolve outstanding supplements and ensure timely payments.
  • Communication
  • Serve as a liaison between roofers, contractors, and insurance carriers to facilitate approvals and resolve discrepancies.
  • Keep contractors informed of claim progress and outcomes, maintaining clear and professional communication.
  • Collaboration
  • Work closely with the Public Adjusters and contractors to coordinate claims and resolve issues effectively.
  • Share insights and feedback with internal teams to enhance workflows and service quality.
  • Process Improvement
  • Provide actionable recommendations to improve supplementing procedures.
  • Help refine internal processes to enhance efficiency, accuracy, and client satisfaction.

What We're Looking For

  • Experience:
  • Minimum of 2 years of experience in supplementing, estimating, or related roles in the roofing or insurance industry.
  • Hands-on experience with insurance claims processes and working with adjusters.
  • Skills:
  • Proficiency with estimating software (e.g., Xactimate or similar platforms).
  • Excellent negotiation and communication skills.
  • Exceptional organizational skills and attention to detail.
  • Ability to manage multiple claims and meet deadlines.
  • Mindset:

We are looking for someone who aligns with our core values and embodies them every day:

  • Tenacious: You're determined to push claims forward, overcome challenges, and achieve the best possible outcomes.
  • Communicative: You prioritize clear, timely, and professional communication with all parties involved.
  • Innovative: You think outside the box to find creative solutions that improve processes and deliver results.
  • We are a TEAM: You value collaboration, support your colleagues, and recognize that we succeed together.

Important Note: This role is 100% remote, but candidates must work American hours. Please only apply if you already have experience in this role. We will not be training people to learn the role — only training experienced candidates on how to use our systems and processes.

Job Type: Full-time

Expected hours: 40 per week

Experience:

  • Xactimate: 1 year (Preferred)

Work Location: Remote

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