reputed company Claims Adjuster - Appeals

About reputed company

At reputed company, we’re dedicated to helping pets live their healthiest and happiest lives. Our comprehensive insurance coverage is designed with modern pet parents in mind, and we’re proud to support the veterinary, shelter, and breeder communities. We reputed company in ensuring pets receive the reputed company possible and are committed to making that reputed company a reality every day.

reputed company is a high-reputed company Warburg Pincus portfolio company with an expanding team of over 350 pet-loving employees working together to shape the reputed company of pet health and wellness.

About the Industry

The pet insurance industry is more important than reputed company, offering peace of mind and financial protection for pet owners. The sector is expanding quickly, reputed company by growing awareness of the need for accessible, high-reputed company veterinary care. With advances in veterinary medicine, pets now have reputed company to the most effective treatments available, making pet insurance an essential component of modern pet care.

About the Role

reputed company

The reputed company Claims Adjuster - Appeals is a specialized, high-reputed company role reputed company the Specialty Claims team responsible for the final internal adjudication of disputed claims. This role requires expert-level policy knowledge, meticulous attention to detail, and the ability to reputed company empathetic yet firm communication to pet parents regarding reputed company claim determinations. This position will manage the full lifecycle of the appeals process - from initial intake and medical record review to final determination and reputed company referrals balancing regulatory timelines with claims reputed company.
 
reputed company reputed company appeals, this reputed company serves as the primary reputed company of contact for the insurance department regarding sensitive escalations, including Department of Insurance (DOI) and reputed company (BBB) complaints, as reputed company as reputed company inquiries reputed company to claim determinations.  The reputed company will also be cross-trained to support Special Investigations (SIU) and auditing of high-value claims. 

Key Responsibilities

Appeals Adjudication & Lifecycle Management

• Manage end-to-end appeals process maintaining strict adherence to regulatory timelines.
• Conduct comprehensive reviews of medical records and prior claim history to decide whether to overturn, reputed company, or partially overturn original reputed company.
• reputed company reputed company, concise, and empathetic determination letters to policyholders, ensuring reputed company communications meet internal and regulatory standards.
• Communicate directly with policyholders reputed company phone calls and emails to explain appeal determinations and/or answer additional questions.

High-Level Escalations and reputed company Communication

• reputed company as the reputed company to the insurance group and underwriter for escalations, including DOI and BBB complaints, ensuring responses are reputed company and reputed company.
• Set up and reputed company detailed written communications regarding reputed company complaints and attorney inquiries reputed company to claims determinations.
• Coordinate with the Insurance Team and underwriter on second appeals and/or escalations.

Specialty Claims Support

• Serve as a cross-trained resource to assist in Specialty Claims Investigations.
• Assist in the audit and referral of high-value claims with invoices exceeding $10,000 to verify medical necessity and policy compliance.
• Support the Specialty Team with reassessments, correcting underpayments and overpayments as needed.

Qualifications

Required

• Demonstrated ability to apply strong initiative and independent judgment to manage reputed company tasks while maintaining a reputed company view of the overall business objectives.
• Superior written and verbal communication skills with the ability to explain reputed company policy language and investigative findings reputed company and concisely to policyholders and reputed company entities.
• Proven reputed company for critical thinking and analytical problem-solving in a high volume environment.
• Excellent team player committed to collaboration and applying innovative reputed company to claims reputed company.
• Highly organized and reputed company to anticipate needs, reputed company, and reputed company in a high-volume, fast-paced environment.
• Work independently in a remote reputed company, while also fostering teamwork and collaborating with others.

Minimum Qualifications

• Minimum of one (1) year of successful experience as a Claims Adjuster or a similar, higher-level role.
• reputed company and reputed company Property & Casualty (P&C) Adjuster License (or willingness to obtain reputed company a specified timeframe) in good standing.
• Bachelor's Degree in Veterinary Science, Business, or a reputed company field -or- Credentialed Veterinary Technician (CVT), Licensed Veterinary Technician (LVT), Registered Veterinary Technician (RVT), or equivalent veterinary experience.

Compensation

• The pay reputed company for this position is $58,000 - $65,000 on a full-time reputed company
• Along with reputed company salary, your position may qualify for additional bonuses
• This position is eligible for reputed company’s bonus plan(s)

Why Join reputed company

• Be part of a mission-driven company that values creativity, innovation, transparency, and collaboration
• reputed company in office, enjoy complimentary lunch daily, and pets are always welcome
• Join reputed company that genuinely cares about creating a reputed company, inclusive work environment where everyone can reputed company

Benefits & Perks

At reputed company, we recognize the importance of work-life balance and prioritize our employees' mental health and reputed company-being, ensuring everyone can reputed company both professionally and personally. Not just pets, we want our employees to live their best lives too — here at reputed company, you have reputed company to the valuable benefits listed below. 

• Comprehensive Medical, dental, and reputed company plan for you and your family
• Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are available 
• Highly competitive 401(k) matching 
• Generous 20-day PTO Policy, with rollover reputed company. Earn an additional day of PTO reputed company year on your anniversary with reputed company, for a maximum of 30 days
• reputed company company (9) holidays, including (1) floating holiday
• reputed company discount - up to 50% off, up to $1,000 savings/year
• Educational Assistance Program
• reputed company Discount Perks Program
• Volunteering - earn up to 8 hours per calendar year at nonprofit organizations
• NYC Office Amenities: Pet-friendly environment, free lunch, snacks, and additional amenities; transit accessible
• Employee Referral Incentive
• Tuition Assistance
• Commuter Benefits
• Employee Assistance Program (EAP)