Lead Claims Adjuster - Appeals

About Fetch At  Fetch , we’re dedicated to helping pets live their healthiest and happiest lives. Our comprehensive insurance coverage is designed with modern pet parents in mind, and we’re proud to support the veterinary, shelter, and breeder communities. We believe in ensuring pets receive the best care possible and are committed to making that vision a reality every day. Fetch is a high-growth  Warburg Pincus  portfolio company with an expanding team of over 350 pet-loving employees working together to shape the future of pet health and wellness. About the Industry The pet insurance industry is more important than ever, offering peace of mind and financial protection for pet owners. The sector is expanding quickly, fueled by growing awareness of the need for accessible, high-quality veterinary care. With advances in veterinary medicine, pets now have access to the most effective treatments available, making pet insurance an essential component of modern pet care. About the Role Overview The Lead Claims Adjuster - Appeals is a specialized, high-impact role within the Specialty Claims team responsible for the final internal adjudication of disputed claims. This role requires expert-level policy knowledge, meticulous attention to detail, and the ability to provide empathetic yet firm communication to pet parents regarding complex claim determinations. This position will manage the full lifecycle of the appeals process - from initial intake and medical record review to final determination and underwriting referrals balancing regulatory timelines with claims integrity.   Beyond standard appeals, this Lead serves as the primary point of contact for the insurance department regarding sensitive escalations, including Department of Insurance (DOI) and Better Business Bureau (BBB) complaints, as well as legal inquiries related to claim determinations.  The Lead will also be cross-trained to support Special Investigations (SIU) and auditing of high-value claims.  Key Responsibilities Appeals Adjudication & Lifecycle Management Manage end-to-end appeals process maintaining strict adherence to regulatory timelines. Conduct comprehensive reviews of medical records and prior claim history to decide whether to overturn, uphold, or partially overturn original decisions. Provide clear, concise, and empathetic determination letters to policyholders, ensuring all communications meet internal and regulatory standards. Communicate directly with policyholders via phone calls and emails to explain appeal determinations and/or answer additional questions. High-Level Escalations and Legal Communication Act as the liaison to the insurance group and underwriter for escalations, including DOI and BBB complaints, ensuring responses are professional and timely. Set up and provide detailed written communications regarding legal complaints and attorney inquiries related to claims determinations. Coordinate with the Insurance Team and underwriter on second appeals and/or escalations. Specialty Claims Support Serve as a cross-trained resource to assist in Specialty Claims Investigations. Assist in the audit and referral of high-value claims with invoices exceeding $10,000 to verify medical necessity and policy compliance. Support the Specialty Team with reassessments, correcting underpayments and overpayments as needed. Qualifications Required Demonstrated ability to apply strong initiative and independent judgment to manage complex tasks while maintaining a clear view of the overall business objectives. Superior written and verbal communication skills with the ability to explain complex policy language and investigative findings clearly and concisely to policyholders and legal entities. Proven capacity for critical thinking and analytical problem-solving in a high volume environment. Excellent team player committed to collaboration and applying innovative ideas to claims integrity. Highly organized and able to anticipate needs, innovate, and thrive in a high-volume, fast-paced environment. Work independently in a remote capacity, while also fostering teamwork and collaborating with others. Minimum Qualifications Minimum of one (1) year of successful experience as a Claims Adjuster or a similar, higher-level role. Active and valid Property & Casualty (P&C) Adjuster License (or willingness to obtain within a specified timeframe) in good standing. Bachelor's Degree in Veterinary Science, Business, or a related field -or- Credentialed Veterinary Technician (CVT), Licensed Veterinary Technician (LVT), Registered Veterinary Technician (RVT), or equivalent veterinary experience. Compensation The pay range for this position is $58,000 - $65,000 on a full-time basis Along with base salary, your position may qualify for additional bonuses This position is eligible for the Company’s bonus plan(s) Why Join Fetch Be part of a mission-driven company that values creativity