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Tpa Claims Examiner
4 months ago
**About Us**
At Davies, we get it... you are not just looking for a job, you are looking to build a life and a career. We believe in our people and realize that our success is a direct result of creating a learning atmosphere, leadership opportunities, and promoting from within. We believe that engaging in corporate social activities and working together as a team is a vital part of the Davies culture.
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.
- 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 Claims North America is seeking an experienced **TPA Claims Examiner** to fully handle Property and Liability claims. Reporting to the Manager of E&S TPA Unit, you will determine liability and/or coverage of newly acquired claims by using three-point contact and other investigative techniques.
To be successful in this role, you must possess a thorough understanding of claims investigation and claims handling, reviewing coverage, reporting to carriers, and preparing Reservations of Rights and Coverage Denials for domestic insurance carriers and Underwriters at Lloyds of London. You must also exhibit a focused investigation of property losses to determine the origin and cause of loss and make coverage recommendations, as necessary. You must have 1-2 years of experience handling full adjustment claims, be able to use a Claims Management System, Microsoft Office Suite, and maintain required CEUs. Additionally, you must have excellent working knowledge of liability laws and principles, rules, procedures, and case law, as well as knowledge of medical terminology and procedures. This role is a full-time, home-based position and will require on-site client meetings at times.
**Responsibilities and Duties**
- Determine liability and/or coverage of newly acquired claims by using three-point contact and other investigative techniques
- Set and adjust reserve amount accordingly based upon independent investigation and judgement
- Make prompt contact with all parties to gather facts and make determinations as to potential exposure, risks, and for reserve purposes
- Initiate investigation and assign appropriate defense counsel when suit is filed
- Regularly communicate with and direct defense counsel through litigation of claim
- Make timely and proper completion of required forms
- Assist with determining and recommending reserves
- Convey positive attitude and team spirit for optimum provision of services to customers
- Schedule and/or attend client meetings, as necessary
- Maintain Reminder and Workflow requirements
- Maintain working knowledge of Liability and Property Statutes and Rules
- In consultation with defense counsel, make timely decisions regarding litigated issues
- Attend trials or depositions as required and provide advice and input as to settlement and other issues throughout the trial or deposition
- Evaluate cases for settlement, making appropriate recommendations to clients
- Exercise authority in settlement negotiations up to $100,000, or in the amount previously negotiated with the client
- Determine subrogation potential, document recovery screen, and pursue recovery where applicable
- Make timely notice to the carrier in all cases, meet reporting criteria, and keep the carrier updated on the claim status
- Report to the client as warranted by claim circumstances
- Oversee Field Adjuster activity
- Maintain a high-quality work product
- Maintain required CEU credits
- Perform other duties as outlined and/or assigned by the Claims Supervisor, Claims Manager, or Liability QA Manager
- Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
**Experience and Qualifications**
Required
- 1-2 years of relevant experience handling full adjustment Personal and Commercial Property and Liability claims
- Ability to utilize the Claims Management System
- Ability to utilize Microsoft Outlook, Word, and Excel
- Maintain required CEU credits
- Travel to claims meetings at client locations as needed
- Attend hearings, mediations, and depositions as needed
Preferred
- Associate degree or equivalent work experience
- Experience with Excess and Surplus Lines Market
- Insurance industry knowledge and experience
**Knowledge, Skills, and Abilities**
- Proactive, independent, and takes initiative with consistent follow through
- Supe
