Claim Manager Assistant I

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 & Health is looking for a Claim Manager Assistant I (CMA I) who will be responsible for handling and processing a variety of incoming and outgoing communications in a fast-paced environment, while facilitating timely and accurate claim determinations. You will be responsible for handling all inbound and outbound telephonic, electronic, and mail information supporting the fulfillment of claim requirements from Insureds, physicians, and care providers. As the Claim Manager Assistant I, you will be responsible for providing superior telephonic customer service to insureds and their representatives, as well as providing administrative support to Claim Managers.

To be successful in this role, this must possess a high degree of empathy and professionalism, possess superb verbal and communication skills that are clear and concise, and can work both independently and as a team. You must be proactive and take initiative as this is a fully home-based position. 

Responsibilities and Duties

• Provide exceptional internal and external Customer Support in a phone support role
• Assist insureds, their representatives, and healthcare providers by supporting the processing of highly individualized claim inquiries
• Professionally and appropriately respond and/or forward inquiries by reviewing the established standards and guidelines
• Ensure smooth transition of claim while monitoring aging of assigned tasks meeting turnaround time standards
• Identify and respond to needs of inbound and outbound callers utilizing active listening skills; professionally and appropriately 
• Prepare claims for Claim Manager review and adjudication
• Process and document the daily administrative activities associated with claim notifications including pending, open, and closed claims, utilizing multiple tabs/screens working within a centralized work queue
• Responsible for input of accurate and detailed data and notes consistently meeting established standards
• Maintain electronic file management and organization of incoming and outgoing mail including imaging, indexing, classification of documents, file management, etc.
• Critically review all documentation for completeness, credibility, consistency, and order
• Meet or exceed all established minimum expectations/metrics and goals for the position
• Meet or exceed standards for productivity and quality as established for the role
• Appropriately process all confidential information abiding by HIPAA privacy laws
• Ensure smooth transition of inquiry to appropriate department if/when necessary
• Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
• Perform other duties as assigned

Experience and Qualifications

Required

• High School diploma/GED required or an equivalent combination of education and experience
• Prior customer service experience required
• Excellent organizational skills with an eye for detail

Preferred

• Insurance or medical background preferred
• Understanding of medical terminology preferred

Knowledge, Skills, and Abilities

• Possess a high degree of tact, empathy, and professionalism 
• Exceptional interpersonal skills with an enthusiastic nature and an overall passion for excellence
• Ability to apply learned principles to specific and unique circumstances
• Superb written, telephonic, and verbal communication skills; must be clear and concise
• Detail oriented with the ability to work independently as well as part of a team
• Solid knowledge of Microsoft Office pro