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.
Davies Life & Health is looking for a Claim Manager who will be responsible for managing a daily caseload of Long-Term Care (LTC) Claims in a fast-paced environment. As the Claim Manager, you will utilize claim policies and guidelines to assesses claims to determine if the Insured is benefit qualified and receiving covered services from a qualified provider. You will be responsible for educating policyholders on Policy coverage and will correspond directly with service providers and physicians to resolve claims.
To be successful in this role, this must possess a high degree of empathy and professionalism, possess strong analytical and problem-solving skills, 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
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Use claims guidelines and policy language to interpret LTC policy coverage to determine eligibility
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Evaluate provider qualification and covered services
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Input accurate and complete data, information, and notes into the claims administrative system to document eligibility
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Monitor aging of assigned tasks to ensure established turnaround time standards are met
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Educate claimants and their representatives on policy coverage and claim processes
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Serve as point of contact for claimants and/or their representatives ensuring a positive experience
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Keeps current on state/territory regulations and issues as well as industry activities and trends
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Investigate and analyze medical evidence to determine whether policy benefit qualifier(s) are met
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Consult with claimant’s physician and/or providers as required
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Perform telephonic evaluation of claimant to track progress and determine if care needs change over time, as needed
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Identify claims for escalation and special handling including proposed denials, fraud, and coordination of benefits with other payer sources
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Appropriately process all confidential information abiding by HIPAA privacy laws
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Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
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Perform other duties as assigned
Experience and Qualifications
Required
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High School diploma/GED required or an equivalent combination of education and experience
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A minimum of 1-3 years of claims experience
Preferred
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Insurance Industry knowledge (LTC, Disability, Major Medical, etc.) preferred
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Understanding of medical terminology preferred
Knowledge, Skills, and Abilities
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Possess a high degree of tact, empathy, and professionalism
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Strong analytical and problem-solving skills with ability to manage and prioritize multiple claims, as well as assigned projects
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Exceptional interpersonal skills with an enthusiastic nature and an overall passion for excellence
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Ability to apply learned principles to specific and unique circumstances
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Superb written, telephonic, and verbal communication skills; must be clear and concise
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Detail oriented with the ability to work independently as well as part of a team
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Solid knowledge of Microsoft Office products with ability to learn new system applications quickly
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Exceptional attention to detail with excellent organizational skills
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Solid knowledge of claims and/or long-term care insurance industry and practices
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Understanding of medical terminology
Essential Requirements
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Must have US work rights
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Must speak English
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High School diploma/GED required or an equivalent combination of education and experience
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A minimum of 1-3 years of claims experience
Other Duties
This job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the individual for this job and subject to change with or without notice.
Diversity and 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 and Recognition
We embrace innovation and run an annual competition available for all colleagues to submit their ideas. The top 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 colleagues have moved across into brand new positions to further develop their ideas/projects!
Benefits
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Medical, dental, and vision plans
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401k plan with employer matching
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Paid Time Off, Sick Leave, and Paid Holidays
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Life insurance, short term, and long-term disability plans
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Amazing Executive and Senior leadership as well as fabulous colleagues
Position Type, Work Environment and Physical Demands
This is a home-based, full time, hourly, non-exempt position that predominantly operates remotely from a professional home-based office environment routinely using standard office equipment such as computers, phones, printers, photocopiers, and scanners and requires prolonged periods of sitting at a desk while working on a computer. While performing the duties of this job, the individual will be required to regularly hear and talk. This is a largely sedentary role requiring the ability to sit at a desk, reach outward, use a phone, have use of fingers to operate office equipment such as a keyboard, mouse, phone, printer, copier, and to reach above the head, bend, or stand as necessary.
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