Claims Specialist

Trupanion

70d•Remote

About The Position

As a Claims Specialist, you will combine veterinary medical knowledge, critical thinking, and policy expertise to assess pet insurance claims and deliver accurate, fair, and timely claim decisions. You will review medical records, clinical notes, invoices, and policy information to determine claim eligibility while ensuring consistency with Trupanion and Smart Paws policy guidelines. In this role, you will service as a trusted resource for pet owners, veterinary teams, and internal stakeholders, helping navigate complex claim scenarios with empathy, professionalism, and attention to detail. You will also support the appeals process by conducting secondary claim reviews and providing clear rationale for claim outcomes. Success in this role requires strong analytical skills, sound judgement, curiosity, and the ability to balance policy interpretation with an exceptional customer experience. The ideal candidate brings a combination of veterinary knowledge, customer-facing experience, and problem-solving abilities, allowing them to confidently navigate complex claims while delivering a positive experience for pet owners and veterinary partners.

Requirements

Professional working proficiency in English required
Professional fluency in German or French required
2+ years of experience in a customer-facing veterinary, animal health, pet insurance, or related environment
Strong understanding of veterinary medical terminology, common conditions, treatments, and diagnostic procedures
Experience working directly with clients or pet owners in a veterinary clinic, hospital, or animal health setting is highly preferred
Experience reviewing medical records, supporting patient care, claims adjudication, or insurance operations is considered an asset
Demonstrated ability to learn and navigate multiple systems, processes, and technologies
Proficiency with Microsoft Office applications and other business software
Strong analytical thinking and problem-solving abilities
Excellent attention to detail with a high degree of accuracy and consistency
Ability to assess complex information, identify key details, and make sound decisions
Exceptional written and verbal communication skills
Strong customer focus with empathy and professionalism in challenging situations
Ability to manage multiple priorities and work efficiently across various systems
Adaptability and resilience in a dynamic, evolving environment
Self-motivated with the ability to work independently while contributing to a collaborative team culture
Proactive mindset with a commitment to continuous learning and improvement

Responsibilities

Review veterinary medical records, clinical notes, invoices, and policy information to evaluate claim eligibility and determine claim outcomes
Apply policy language, claims guidelines, and established processes consistently and accurately
Conduct secondary claim reviews as part of the appeals process and communicate claim rationale clearly and professionally
Investigate complex claim scenarios by gathering, validating, and interpreting relevant medical and policy information
Identify missing or incomplete information and proactively obtain required documentation from veterinary clinics, specialists, or pet owners
Communicate with veterinary professionals, pet owners, and internal teams via phone and email regarding claim decisions, status updates, and policy questions
Deliver an efficient, empathetic, and positive experience for pet owners and veterinary partners during potentially sensitive situations
Maintain accurate records and documentation within multiple internal systems
Collaborate with cross-functional teams to support operational excellence and continuous improvement initiatives
Contribute ideas and feedback that enhance claims processes, workflows, and customer experience