What are the responsibilities and job description for the Customer Claims Resolution Representative position at Primary Services?
Join a dynamic organization that prioritizes a strong culture, career growth, and comprehensive benefits while empowering professionals to make meaningful impacts every day. Build your future in a role where your expertise is valued and your contributions drive real results.
Primary Services is excited to announce the role of Customer Claims Resolution Representative for a large and well-established client. This role is in a structured, high-performing claims team where attention to detail and analytical skills are essential. The Customer Claims Resolution Representative will play a critical role in guiding claims through the adjudication process, ensuring accurate coverage determinations, and delivering clear communication to homeowners.
Responsibilities
- Respond to high volumes of claim authorization requests with professionalism and efficiency.
- Evaluate claims eligibility by reviewing diagnosis, product details, tenure, and contract terms.
- Interpret contract language to determine coverage qualification and liability.
- Process cash settlement offers and coordinate contractor dispatch requests.
- Enforce contractor pricing agreements and communicate claim outcomes to homeowners.
- Adhere to call center performance metrics and quality assurance standards.
- Execute timely follow-ups to ensure claims are resolved accurately and efficiently.
- Support cross-functional teams with claim reviews and decision-making processes.
- Participate in resolving complex and sensitive claims as part of a focused remediation team.
- Provide escalation support and subject matter expertise to contact center personnel.
- Analyze customer coverage to recommend additional plan options that enhance benefits.
Qualifications
- High school diploma or equivalent required.
- 2–4 years of experience in claims authorization or a contact center environment preferred.
- Proficiency in Microsoft Excel, Word, and PowerPoint.
- Experience interpreting contracts and applying terms and conditions to real-world scenarios.
- Ability to manage multiple priorities under strict deadlines and performance metrics.
- Experience handling claim adjudication, liability determination, or similar processes.
- Knowledge of call center operations and quality assurance standards.
- Demonstrated experience in negotiation, mediation, or conflict resolution.
- Ability to clearly communicate complex information in both written and verbal formats.
- Experience with upselling or recommending additional services based on customer needs.