Licensed Claims Adjuster at Cover Genius

New York, New York, United States -

Full Time

Start Date

Immediate

Expiry Date

09 Oct, 26

Salary

0.0

Posted On

11 Jul, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Adjudication, Policy Interpretation, Regulatory Compliance, Fraud Identification, Investigation, Customer Communication, Risk Management, Case Documentation, KPI Management, Analytical Thinking, Time Management, Collaboration

Industry

technology;Information and Internet

Description

About the Company Cover Genius is a Series E Insurtech [https://covergenius.com/media/cover-genius-closes-80m-in-series-e-funding-as-investors-see-700-billion-opportunity-in-embedded-protection/]that protects the global customers of the world’s largest digital companies including Booking Holdings, owner of Priceline, Kayak and Booking.com [http://booking.com/], Intuit, Hopper [https://covergenius.com/hopper-demo/], Skyscanner [https://covergenius.com/skyscanner-demo/], Ryanair [https://covergenius.com/ryanair-demo/], Turkish Airlines, Descartes ShipRush, Zip and SeatGeek. We’re also available at Amazon [https://covergenius.com/available-at-amazon/], Flipkart [https://covergenius.com/flipkart-demo/], eBay [https://covergenius.com/global-online-retailer-513-growth/], Wayfair and SE Asia’s largest company, Shopee. Our partners integrate with XCover [https://covergenius.com/xcover/], our award-winning insurance distribution platform, to embed protection for millions of customers worldwide each year. Our team and products have been recognized with dozens of awards including by the Financial Times who ranked Cover Genius as the #1 fastest growing company in APAC [https://www.ft.com/content/1d5aabcc-5d44-11ea-ac5e-df00963c20e6] in 2020. Our diverse team across 20+ countries and many language groups commits itself to diverse cultural programs, in particular “CG Gives” [https://covergenius.com/cg-gives/] which makes social entrepreneurs out of us all and funds development initiatives in global communities. Our People are Bold, Authentic, Purposeful and Inspired Our People are not Perfect, Traditional, Complacent or Cautious ABOUT THE ROLE We are seeking a Licensed Claims Adjuster who will be responsible for adjudicating regulated insurance claims within the Digital Commerce vertical. This role sits at the intersection of regulatory compliance, policy interpretation, and operational performance. The position combines traditional claims handling responsibilities—such as conducting investigations, reviewing documentation, interpreting policy language, issuing coverage determinations, and maintaining detailed file documentation—with elevated authority to handle regulated and complex files requiring state licensure. This is not a purely administrative role nor a purely customer service role, but a specialized position designed to strengthen compliance, technical accuracy, and financial risk controls across the claims function. You will collaborate closely with the Claims Manager and cross-functional stakeholders to ensure timely, compliant, and well-reasoned determinations on complex and/or high-exposure claims related to electronics, appliances, furniture, and other retail goods. Combining sound coverage judgment and disciplined documentation, you will help safeguard claim quality while maintaining operational efficiency. Key Responsibilities * Claims Adjudication: Manage end-to-end handling of regulated insurance claims, including investigation, coverage analysis, formal determination, claim actions, communications, and payment issuance related to retail, electronics, appliances, and furniture within defined service-level agreements (SLAs) . * Claim Determination: Interpret policy language and underwriting guidelines to issue compliant, well-reasoned coverage decisions in accordance with applicable state insurance regulations. * Complex & Escalated Files: Handle high-exposure, sensitive, or escalated claims requiring licensed authority and independent judgment. * Regulatory Compliance: Maintain active state licensure and ensure adherence to jurisdictional insurance laws, DOI requirements, and internal governance standards. * Fraud & Risk Identification: Identify potential fraud indicators and escalate appropriately in line with company protocols and fraud thresholds. * Customer Communication: Respond to customer inquiries via phone, email, or chat regarding claim status, documentation, and coverage decisions, communicating complex determinations clearly and professionally. * Documentation & Audit Readiness: Ensure all required documentation is collected, reviewed, and accurately recorded in the claims system to support audit integrity and regulatory compliance. * Quality & KPI Performance: Maintain high levels of claim accuracy and timeliness in alignment with business, team, and individual performance metrics. * Technical Support & Collaboration: Provide guidance to non-licensed assessors on policy interpretation and complex files; collaborate with Claims, Support, and Compliance teams to ensure efficient and consistent resolution. * Process Improvement: Identify and recommend operational improvements to enhance efficiency, reduce leakage, and strengthen internal controls within the Digital Commerce vertical. Skills & Experience * Active U.S. state Adjuster License in good standing (multi-state or reciprocal licenses preferred). * 2+ years of experience handling regulated insurance claims, ideally across electronics, appliances, or furniture, financial/credit card/NAC programs a plus. * Strong knowledge of digital commerce and retail supply chain operations, including warranty and service contract programs. * Familiarity with repair networks and ability to coordinate repair assessments and turnaround processes. * Solid understanding of jurisdictional insurance regulations and fair claims handling practices. * Strong analytical and investigative skills with sound judgment in evaluating documentation and determining coverage. * Excellent written communication skills, particularly in drafting clear, defensible claim determinations. * Experience working in a KPI-driven environment with accountability for quality and turnaround time. * Ability to operate independently in a fully remote environment with strong organizational and time-management skills. * Proficiency in claims management systems and digital documentation platforms. * Collaborative mindset with the ability to provide technical guidance and support to junior or non-licensed team members. * Bachelor's degree in a relevant field, A postgraduate degree and/or record of academic achievement is also desirable. What you will have: * Investigative rigor with ability to verify claims through documentation and repair assessments. * High attention to detail, ensuring accuracy in case handling and valuation. * Customer-first approach, resolving escalations with empathy and professionalism. * Strong analytical skills to spot claim trends, systemic risks, and recurring product issues. * Confident, timely decision making in complex or high-value cases. * Clear communication and collaboration skills with retail partners, repair networks, and compliance. Why Cover Genius? Cover Genius not only cares about being the best in our industry, we care about our team. We’re a business that understands life can be fluid and so we flex to ensure we provide the environment to suit that. What does that mean? • Flexible Work Environment - our team is remote. • Global company, with the opportunity to work from any of our offices for 4 weeks a year • Work with like-minded people who are passionate about both the work we're doing and giving back. Our CG Gives programs enables us to all become philanthropists through our peer recognition and rewards system. • Social Initiatives - pictures [https://www.instagram.com/p/B9qnOuUpDVx/]speak a thousand words! Sound interesting? If you think you have the best composition of the above, send us your resume and let's chat! * Cover Genius promotes diversity and inclusivity. We don't tolerate discrimination, demeaning treatment of anyone, or harassment due to race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or any other legally protected status. By submitting your application, you acknowledge that we may collect, store and process your personal data for recruitment purposes. To ensure a fair evaluation, we may use AI to assist in sorting applications, but all final decisions are made by our hiring team and no candidate dispositions are automated. We will keep your information on file for three years from the date of your application. For detailed information about how we handle your data and our use of AI, please review our full Privacy Policy. [https://covergenius.com/privacy-policy/]

Responsibilities

Responsible for adjudicating regulated insurance claims within the Digital Commerce vertical, focusing on electronics, appliances, and furniture. The role involves conducting investigations, issuing coverage determinations, and ensuring strict adherence to state insurance regulations.