Brief Role Description

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

Role Summary

The Claims and Process Guidelines 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 will support the attainment of yearly revenue and sales targets, for Insurance, through the ongoing operational management of insurance and service products, building and maintaining efficient business processes. Additionally, the Claims and Process Guidelines Sr Specialist will work closely with the internal and external lending organizations as well as hired contract administrators to ensure efficient and compliant, customer-centric business processes for claims operations of the underwritten products. This role will also be responsible in ensuring that the Claims guidelines in our products policies are adhered to and aligned with the Brand claims adjudication guidelines. Ensure that the Adjudication team is adhering to the claim guidelines as set by VWFS program.

Job Responsibilities within this Role

Claims Management (35%)

• 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.

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.

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 policyholders, brokers, 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 and customer satisfaction.

Reporting & Analysis (15%)

• 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.

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.

Specialized Skills:

• Proficiency in claims management systems (e.g., Guidewire, ClaimCenter).
• Strong analytical skills with experience in data analysis and reporting tools.
• Knowledge of insurance policy structures and coverage types.
• Understanding of fraud detection techniques and litigation processes.
• Advanced proficiency in Microsoft Office Suite (Excel, Word, PowerPoint).

Desired Skills:

• FCAS designation
• Ability to use SAS/Python
• Personal or commercial auto insurance experience
• Excellent Excel skills and strong with SQL

Qualification requirements

• 7+ years of OEM / Financial Services experience related to automotive and/or financial products and services with a focus on operations, business process management and data management. 
• Experience in developing and implementing process guidelines or SOPs.
• Familiarity with regulatory frameworks such as IFRS 17, privacy laws, and insurance compliance standards.
• Minimal travel – 5%
• Role may require occasional/seasonal work outside of normal working hours.

Preferred:

• 3–5 years of experience in insurance claims processing or claims operations.
• 3-5 years of professional experience specific to operations of automotive financial protection products

Required Education:

• Bachelor’s degree in business administration, Finance, Insurance, or a related field.
• 3-5 years of project management and / or business process modelling experience.

Desired Education:

• Master’s Degree in a related field
• Professional certifications such as:
• Associate in Claims (AIC)
• Certified Claims Professional (CCP)
• Chartered Insurance Professional (CIP) (preferred)
• Project Management Certification / PMP