Claims Adjudicator

Description

Job Summary: Responsible for the full analysis, management, and adjudication of claims processes, ensuring technical accuracy and assertive communication with all stakeholders. Key Highlights: 1. Complete analysis and management of claims processes. 2. Clear and assertive communication with policyholders and partners. 3. Support for continuous improvement of claims adjudication processes. **Claims Adjudicator** Responsible for the full analysis, management, and adjudication of claims processes, ensuring technical accuracy, compliance with internal policies and applicable legislation, and maintaining clear and assertive communication with policyholders, repair shops, suppliers, brokers, and other stakeholders. **Responsibilities**: * Receive, analyze, and manage claims processes from initiation through closure. * Perform document triage and verify compliance with insurance rules and internal procedures. * Evaluate estimates, technical reports, and information submitted by repair shops, suppliers, and experts. * Request and validate supplementary information, revisions, and adjustments to estimates and documents when necessary. * Record all information in the internal system, maintaining an updated and complete history. * Provide support to policyholders and brokers, delivering updates on claim status. * Identify inconsistencies, risks, or fraud indicators and escalate to technical analysis as applicable. * Maintain ongoing alignment with external adjudicators, assistance providers, and other process partners. * Meet internal deadlines and SLAs defined by operations. * Support continuous improvement of adjudication processes and standardization of routines. **Requirements**: * Bachelor’s degree completed or in progress in Administration, Law, Engineering, or related fields. * Prior experience in claims adjudication, customer service, or roles related to the insurance industry. * Familiarity with claims systems such as Cilia, Wecare, or similar platforms. * Basic knowledge of automotive mechanics (for auto claims). * Understanding of insurance sector legislation and regulations. * Proficiency in Microsoft Office and strong written communication/organizational skills. **Benefits**: * Salary negotiable. * On-site meals. * Health insurance. * Dental insurance. * Mobility allowance. * Career development plan. * Partnerships with universities. **Working Hours**: Monday to Friday, from 08:00 to 17:48\. **Location**: Enseada do Suá, Vitória/ES. Employment Type: Full-time, CLT. Compensation: Starting at R$3\.214,00 per month. Benefits: * Medical assistance. * Dental assistance. * Transportation allowance. Work Location: On-site