Claim Representative

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 an experienced Claim Representative (Long-Term Care) who will be responsible for handling claim payments in accordance with an approved Plan of Care provided by our business partner, along with managing a caseload of new and ongoing Long-Term Care insurance claims on behalf of client insurance companies in accordance with Davies Life & Health practices, contractual provisions, and statutory requirements.  This includes handling all inbound and outbound telephonic, electronic, and mail supporting the fulfillment of claim requirements and information needed to process reimbursements. The Long-Term Care Claim Representative is responsible for providing superior customer service to insureds and their representatives, as well as our clients and business partners.

To be successful in this role, you need to have superb written and verbal communication skills to communicate effectively with clients and possess a high level of empathy. You must have strong time management skills to balance working with multiple tasks simultaneously, strong organizational skills, and possess the ability to work in a fast-paced environment, handling a high-volume caseload. Additionally, you will need to be proactive, independent, and take initiative as this is a full-time, fully home-base position. 

Responsibilities and Duties

• Assist insureds, their representatives, and healthcare providers by promptly responding to all inquiries
• Professionally and appropriately respond to inquiries within our authority, and/or promptly forward inquiries to our client/business partners as appropriate
• Provide claim information to Policyholders and their authorized representatives and respond to verbal and written inquiries within established service level agreements and regulatory timeframes
• Timely and accurate documentation of conversations via phone memos or other appropriate documentation
• Prepare and send claim acknowledgement letters, approval letters, and other Long-Term Care form letters as required and in accordance with service level agreements and regulatory timeframes
• Record and upload all information in claim files (forms, letters, emails, phone memos) and input data into electronic systems to track activities and claim status, disburse benefits
• Request and document bed day verification monthly for all Facility/Nursing Home care claims 
• Accurately record provider information in IDEAS; obtain completed W9 forms as necessary
• Review Long-Term Care invoices, monthly bed day verification forms, caregiver logs, and all other claims documentation received to determine proper payment amount in accordance with the approved Plan of Care provided by our business partner
• Accurately enter payment in the IDEAS system; ensure accurate benefit amounts, from and through paid dates, proper payee, proper provider, and any declined/unapproved amounts recorded on EOBs
• Appropriately handle confidential information by abiding by HIPAA privacy laws as well as Davies Life & Health’s Code of Business Conduct
• Confirm validity of Power of Attorney documents and/or other documents authorizing non-insureds to receive confidential and/or private claimant information  
• Consult with management and/or the Law Department as needed
• Effective, professional, and accurate communications with Policyholders, as well as client company personnel, co-workers and Davies Life & Health management personnel
• Participate in on-site Davies Life & Health training programs
• Support company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
• Perform other duties as assigned

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