Complaints Triage Officer

The Complaints Triage Officer is responsible for the first-line review of customer complaints received across Cover Genius's support channels. This role requires someone who can read a complaint carefully, correctly interpret what the customer is raising, and apply the company's complaints handling process precisely and consistently, every time. Accuracy, discipline in following procedure, and sound judgement on when to escalate are essential, as triage decisions affect regulatory compliance, customer outcomes, and downstream teams such as Claims, Underwriting, and Compliance.

Key Responsibilities:

• Read and review incoming complaints across all channels (Zendesk tickets, email, and complaints escalated from partners) to accurately understand the nature, severity, and root cause of each case.
• Interpret complaint content against Cover Genius's complaints handling policy and applicable regulatory requirements (for example, internal dispute resolution timelines) to determine the correct classification and next steps.
• Triage each complaint by category (such as claims decision, policy wording, sales or mis-selling, service delivery, or billing) and by severity or priority, strictly in line with the defined process.
• Follow the complaints triage workflow in the correct sequence for every case, without skipping or reordering steps, so outcomes remain consistent and auditable.
• Log and document each complaint accurately in Zendesk (or the designated system), including classification, evidence reviewed, and actions taken.
• Escalate complaints that meet defined thresholds (regulatory risk, vulnerable customer indicators, high severity, or repeat complaints) to Compliance or the relevant specialist team within SLA.
• Identify and refer complaints that require specialist handling by Claims, Underwriting, or Legal/Compliance.
• Meet SLA turnaround times for triage and initial response on every case.
• Maintain strict confidentiality of customer and policy information at all times, in line with Cover Genius's data handling policy.
• Flag recurring themes, unclear cases, or gaps in the triage process to the Complaints & Compliance Team Lead to support continuous improvement.

Standard Triage Process (indicative)

The Officer follows the documented SOP for every complaint received. The steps below are indicative of the level of process discipline required; the full, current SOP and category-specific checklists are provided during onboarding and take precedence.

• Acknowledge and log the complaint in the system of record within the required timeframe.
• Read the complaint in full before taking any action, noting the customer's stated issue, desired outcome, and any supporting evidence attached.
• Identify the relevant policy, partner, and product, and pull any related booking, claim, or prior contactm history.
• Classify the complaint by category and severity using the current classification checklist.
• Check for escalation triggers (regulatory risk, vulnerable customer, high severity, repeat or unresolved complaint) and escalate immediately if any are present.
• Where no escalation is required, determine the correct next step or owning team per the SOP decision tree.
• Record the classification, rationale, and evidence reviewed in the case file so the decision is fully auditable.
• Hand off or close the case only once every required checklist item for that complaint category is complete.
• Where any part of the complaint is ambiguous or the correct classification is unclear, pause and raise it with a supervisor rather than making an assumption.

Process Adherence Requirements

Minimum requirements (screen on these)

• Excellent written English comprehension: able to read a multi-paragraph complaint and accurately restate what is being alleged and what outcome is sought.
• Demonstrated ability to follow a detailed, multi-step process or checklist exactly and consistently, without skipping or reordering steps.
• Comfortable working in a rules-based, audit-driven environment where every decision must be documented and justified.
• Willingness and ability to learn a new ticketing or case management system quickly (prior Zendesk experience is not required).

Preferred, not required (use to prioritize, not to reject)

• Prior experience in complaints handling, customer support, or a BPO environment, ideally within insurance, financial services, or another regulated industry.
• Background in QA, transaction monitoring, back-office processing, or claims adjudication at another BPO or an insurer.
• Familiarity with insurance terminology (claims, policy, underwriting).
• Experience with ticketing or CRM systems such as Zendesk.

Skills & Attributes

• Meticulous attention to detail.
• Strong analytical and critical thinking skills.
• Ability to remain calm and objective when reviewing sensitive or emotionally charged complaints.
• Sound judgement on when to resolve independently versus escalate.
• Comfortable operating within a regulated, audit-driven environment.
• Strong time management and ability to work to SLA under volume.

Key Performance Indicators

• Triage turnaround time against SLA.
• Classification accuracy, measured through QA sampling.
• Escalation accuracy (correct complaints escalated; no under- or over-escalation).
• Completeness of the audit trail on closed and escalated cases.
• Adherence to the documented SOP (process compliance score).