Claim Consultant

About Us

With a multinational global team, Davies Group is a specialist professional services and technology firm working in partnership with leading insurance, highly regulated, and global businesses.

At Davies Group, we help clients to manage risk, operate core business processes, and to transform and grow. We deliver operations, consulting and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation, customer experience, human capital, transformation, and change management.

Davies Life & Health, Inc. is a Davies affiliate that predominantly focuses on the administration of disability and long-term care products on behalf of numerous clients, including some of the most well-known insurers and reinsurers in the United States.

Are you looking for a company that is Dynamic and Innovative where the employees are Connected and Succeed Together? If so, Davies may just be the right choice for you.

Job Overview

Davies Life and Health is looking for a Claim Consultant who will be responsible for investigating, adjudicating, administering, and managing a caseload of new and ongoing disability insurance claims on behalf of client insurance companies in accordance with Davies Life & Health’s practices, contractual provisions, and statutory requirements. As a Claim Consultant, you will report to the Director of Claims while you investigate and analyze claims, communicate claim decisions and status, as well as document the claim process and outcomes while controlling costs associated with claim management.

To be successful in this role, you should have experience with conflict resolution, possess strong analytical and recall skills, be driven and possess the ability to multitask in a fast-paced environment. You must be proactive and take initiative as this is a full time, home based position.

Responsibilities & Duties

• Develop and implement plans to thoroughly investigate claims. Gather directly, or through third party vendors of investigation services, information required to fully objectify claims and render claim decisions
• Thoroughly review and analyze all claim information, review, and apply appropriate contractual provisions and consult with resource and management personnel to ensure the timely and fair adjudication of all claims
• Render, document and communicate claim decisions within assigned authorization limits and upon obtaining appropriate management concurrence (as specified by Senior management)
• Provide claim status to Policyholders and their authorized representatives and respond to verbal and written inquiries
• Record information in claim files and input data into electronic systems to track activities and claim status, disburse benefits, and produce management reports
• Communicate effectively with Policyholders and internal and external medical, legal, and investigative resource personnel, as well as client company personnel and management personnel
• Plan and coordinate investigative activities required to objectify each claim, obtain information, and coordinate activities and resources required to assess disability; monitor claimants’ disability status and return-to-work potential; and identify and resolve issues that introduce uncertainty as to the disposition of each claim and coordinate claim resolution initiatives
• Provide mentoring support to Claim Representatives
• Consult on cases directly with Client insurance companies in on-site consulting engagements when assigned
• Cost-effectively utilize and manage investigative resources and associated expenses
• Participate in special projects as requested and perform other related job functions as required
• Support company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
• Perform other duties as assigned

Experience & Qualifications

Required

• Bachelor’s degree or equivalent combination of education and experience
• A minimum of 3 years’ experience managing individual disability, LTD or workers compensation claims or equivalent disability claim representative experience

Preferred

• Bilingual in English and Spanish
• Experience in conflict resolution
• Knowledge of disability insurance and medical terminology

Knowledge, Skills, & Abilities

• Proactive, independent, and takes initiative with consistent follow through
• Superior time management skills with capability of working with and meeting deadlines
• Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment
• Excellent interpersonal skills to effectively communicate across the organization
• Capable of working collaboratively and independently with minimal supervision
• Effective conflict management and negotiation skills
• Excellent cognitive ability, analytical skills, organization, and recall
• Possess the ability to train and coach team members
• Flexible and able to adapt to changes in the work environment

Essential Requirements

• Must have US work rights
• Must speak English
• Bachelor’s degree or equivalent combination of education and experience
• A minimum of 3 years’ experience managing individual disability, LTD or workers compensation claims or equivalent disability claim representative experience

Diversity & Inclusion

Davies is committed to being a diverse and inclusive workplace. We welcome candidates of all genders, gender identity and expression, neurodiversity, sexual orientation, disability, physical appearance, body size, race, age, nationality, and belief (or lack thereof).

Rewards & Recognition

We embrace innovation and run an annual competition available for all teammates to submit their ideas. The top 10 finalists travel to the current year’s competition site where they pitch their ideas to our investors. The winner receives funding to bring their idea to life and the runners up receive a reward for their involvement. Some of our teammates have moved across into brand new positions to further develop their ideas/projects!

Benefits

• Medical, dental, and vision plans
• 401k plan with employer matching
• Paid Time Off, Sick Leave, and Paid Holidays
• Life insurance, short term, and long-term disability plans
• Amazing Executive and Senior leadership as well as fabulous teammates

Role Classification & Work Environment

This role is a home-based, full-time, exempt role. This position operates in both a professional office and a home-based office and routinely uses standard office equipment such as laptops, printers, and phones. While performing the duties of this job, the individual will be required to regularly hear and talk. This is a sedentary role that requires the ability to sit for prolonged periods at a desk, reach outward, use a phone, use of fingers to use office equipment such as a keyboard, mouse, phone, printer, copier, and to reach above the head, bend, or stand, as necessary.