Senior Claims Manager Jobs in Puerto Rico (NOW HIRING)

Job Purpose
The Senior Auto Claims Analyst is a senior individual contributor responsible for governing claim outcomes, coverage interpretation, and operational consistency for vehicle service contract programs and other ancillary products related to the auto industry. This role provides technical authority, analytical leadership, and escalation oversight to ensure claims are handled accurately, consistently, and in full compliance with contract terms, regulatory requirements, and internal controls.
Primary Job Responsibilities

Claims Governance & Technical Authority

• Serve as the technical authority for coverage interpretation, exception handling, and complex claim scenarios.
• Determine appropriate repair measures based on research, peer-to-peer examination, and job experience.
• Act as the final escalation point for high-risk, high-exposure, or precedent-setting claims.
• Establish and maintain adjudication standards, decision frameworks, and interpretation guidance to ensure consistency across teams.
• Ensure alignment between contract intent, regulatory requirements, and operational execution.

Offshore Adjudication Oversight & Quality Enablement

• Provide indirect oversight and technical direction to offshore claims adjudication teams.
• Conduct targeted case reviews, calibration sessions, and thematic deep dives to assess quality and consistency.
• Identify systemic gaps and drive corrective actions through training updates, documentation, or process enhancements.
• Support alignment between onshore expectations and offshore execution without direct people management.

• Data Analysis, Insights & Forecasting

• Analyze claims data to identify trends in frequency, severity, leakage, repair practices, and operational performance.
• Translate analytical findings into actionable recommendations that improve outcomes, controls, and efficiency.
• Support forecasting of claim volume, severity, and repair mix to inform planning and risk management.
• Partner with leadership, analytics, and finance teams to improve reporting and decision visibility.

• Repair Network Governance & Optimization

• Develop and monitor governance standards for client-owned repair facilities.
• Assess adherence to contractual requirements, repair practices, quality standards, and cost controls.
• Identify optimization opportunities related to cycle time, repair accuracy, cost containment, and customer experience.
• Escalate performance or compliance concerns and recommend corrective actions or operational enhancements.

• Compliance, Audit & Continuous Improvement

• Support internal audits, quality assurance reviews, and regulatory inquiries through expert analysis and documentation.
• Identify control weaknesses and contribute to sustainable remediation plans.
• Develop and maintain training materials, job aids, and knowledge resources that strengthen claims capability and consistency.
• Actively contribute to continuous improvement initiatives across claims, repair networks, and supporting processes.

Required Qualifications

• Bachelor's degree, preferably in Engineering, Business Administration, Finance, Accounting, Risk Management or Insurance.
• 5+ years of experience in auto claims, extended warranties, or vehicle service contract administration.
• Demonstrated expertise in interpreting vehicle service contracts, exclusions, and endorsements.
• Strong understanding of automotive systems, repair diagnostics, labor guides, and repair facility workflows.
• Experience analyzing claims data and translating insights into operational or governance improvements.
• Familiarity with state regulatory requirements applicable to vehicle service contracts or insurance-adjacent products.
• Proven ability to influence outcomes across distributed or offshore teams without direct supervisory authority.

Core Competencies

• Analytical Judgment: Applies data, contract language, and risk assessment to complex decisions.
• Systems Thinking: Understands how claims, repair networks, controls, and customer outcomes intersect.
• Influence Without Authority: Leads through expertise, credibility, and collaboration.
• Attention to Detail: Ensures decisions and standards are accurate, defensible, and compliant.
• Clear Communication: Articulates complex decisions and insights effectively to diverse stakeholders.
• Continuous Improvement Mindset: Proactively identifies opportunities to strengthen outcomes and efficiency.