Brief Role Description

This position is Career Level 20P, located in Reston, VA, with a Role Classification of Hybrid.

Role Summary

The Auto Claims Analysis Sr Specialist is responsible for managing and optimizing the end-to-end insurance claims process. This role ensures that claims are handled efficiently, accurately, and in compliance with internal policies and external regulations. The Sr. Specialist also develops, maintains, and enforces process guidelines to support operational excellence and regulatory adherence across the claims department.

This role is responsible for:

• Ensuring claim adjudication occurs within all laws, regulations, and company guidelines.
• Ensuring accurate collection and maintenance of claim and repair data from a variety of sources.
• Identifying emerging and current trends in the macro and internal environment for use in product pricing, reserving, and loss control functions.
• Using internal and Brand data to assist in the risk classification process.
• Refining processes, procedures, and guidelines.
• Auditing adherence of claims and process execution by contract administrators and staff to ensure compliance.

Job Responsibilities within this Role

Process Guidelines & Compliance (35%)

• Develop and update claims handling procedures and process documentation.
• Ensure compliance with industry regulations (e.g., provincial insurance laws, privacy standards).
• Monitor adherence to internal claims guidelines and recommend improvements.
• Conduct audits and quality assurance reviews to identify gaps and training needs.
• Collaborate with legal and compliance teams to align claims processes with regulatory changes.

Reporting & Analysis (35%)

• Track and report on macro environment trends and other indicators of future loss trends.
• Track and report on claims trends, performance metrics, and operational KPIs.
• Identify areas for process optimization and automation.
• Prepare reports and recommendations for senior management.

Stakeholder Collaboration (15%)

• Work with third-party administrators (“TPA”), insurance companies, and consultants to develop and maintain solid business structures and processes in line with internal process requirements and maintenance of third-party lender-related processes, including managing Vendor PO’s and Payments, and managing CLIP Fees and Reporting
• Program Manual Updates as required by the business unit
• Liaise with customers, dealers, adjusters, and legal counsel to gather information and resolve claims.
• Provide guidance and training to claims staff on process standards and best practices.
• Support cross-functional initiatives to improve claims efficiency, customer satisfaction and fraud prevention.

Claims Management (15%)

• Work closely with VWFS Customer and Dealer Operations to build and effectively run all operational processes of the branded financial protection products for Volkswagen, Audi & Ducati customers in the US market – product activation and lifetime contract management, including issue resolution and case management.
• Review and process insurance claims from initiation to resolution, ensuring accuracy and timeliness.
• Investigate claims to determine validity, coverage, and liability.
• Analyze documentation and data to assess damages and identify potential fraud.
• Negotiate settlements with claimants, legal representatives, and other insurers.
• Resolve disputes and escalate complex cases as needed.
• Maintain detailed records of claims activities and outcomes.

Qualification requirements

Years of Relevant Experience:

• 7+ years of experience analyzing data, developing and managing processes, and driving operational results in an automotive manufacturer, financial services, or insurance environment. 
• Experience implementing, refining, and auditing process guidelines or standard operating procedures.
• Familiarity with regulatory frameworks such as privacy laws, and insurance compliance standards.

Preferred:

• 3–5 years of experience in automobile physical damage and/or mechanical breakdown claims processing or claims operations.
• 3-5 years of professional experience specific to operations of automotive financial protection products.
• 3-5 years of project management and / or business process modelling experience.

Required Education:

• Bachelor’s degree in business administration, Finance, Insurance, or a related field.

Desired Education:

• Master’s Degree in a related field

Professional certifications such as:

• ASE
• I-CAR
• Project Management Certification / PMP

Skills Needed to perform the Job:

• Ability to conduct large-scale projects and research through all stages: concept formulation, the definition of metrics, determination of appropriate methodology, research evaluation and final research report
• Specialized ability to communicate highly technical subjects to senior executives and others who have limited background in mathematics or statistics
• Analytical and conceptual thinking – the ability to understand business problems and develop data-driven solutions
• Strong problem-solving and decision-making capabilities.
• Ability to work independently and collaboratively in a fast-paced environment.

Specialized Skills:

• Strong knowledge related to automobile mechanical and/or collision repair.
• Strong analytical skills with experience in data analysis and reporting tools.
• Understanding of fraud detection techniques.
• Excellent Microsoft Excel and Powerpoint skills.

Desired Skills:

• Ability to use SAS/Python
• Personal or commercial auto insurance experience
• Excellent Excel skills and strong with SQL
• Knowledge of insurance policy structures and coverage types.