Job Details

Claim Manager Assistant I (Remote)

Imagine being part of a team that's not just shaping the future but actively driving it. At Davies North America, we're at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital partof the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.

We are on the lookout for a Claim Manager Assistant I who will be responsible for handling and processing a variety of incoming and outgoingcommunications in a fast-paced office environment facilitating timely and accurate claim determinations. This includes handling inbound and outbound telephonic, electronic, and mail information supporting the fulfillment of claim requirements from Insureds, physicians, and care providers. The CMA I is responsible for providing superior telephonic customer service to insureds and their representatives, as well as administrative support to Claim Managers.

Key Responsibilities

1) 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

2) 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 que
• Responsible for input of accurate and detailed data and notes consistently meeting established standards
• May perform additional duties and/or assist with special projects as required

3) File management and organization

• 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
• Ability to recognize possible process deficiencies and suggest viable solutions

4) 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

5) May perform additional duties as assigned This is a full-time remote role.

Skills, knowledge & expertise

• High school degree or equivalent experience required; business experience preferred
• Prior customer service experience required; insurance or medical background preferred
• Excellent organizational skills with an eye for detail
• Understanding of medical terminology a plus
• Proven interpersonal, verbal, telephonic, and written communication skills
• Must possess a high degree of tact, diplomacy and professionalism when dealing with all types of customers
• Ability to prioritize work using organizational and decision-making skills
• Must be detail oriented with ability to work independently as well as be part of a team
• Solid knowledge of Microsoft Office Products as well as other business-related software
• Ability to learn new system applications quickly
• Ability to quickly apply learned principles to specific and unique circumstances

Equal Employment Opportunity & Legal Notices

At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes:

• Medical, dental, and vision plans to support your health and that of your family
• A 401(k) plan with employer matching
• Time-off policies, including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for non-exempt employees
• Paid holidays
• Life insurance and short-term and long-term disability coverage

Benefit offerings, eligibility, and required employer contributions may vary based on role, classification, and applicable federal, state, and local laws, including those tied to an employee's primary work location. Where required by law, the Company provides paid sick leave, paid family and parental leave, and other mandated benefits in accordance with applicable state and local requirements.

Davies is dedicated to fostering a diverse and inclusive workplace that embraces a wide range of perspectives and experiences. We believe that diversity of thought is essential for innovation and creativity, and we actively promote an environment where all voices are valued and heard.

The salary range listed reflects the full compensation band for this role across all locations. Actual compensation will be based on factors such as skills, experience, qualifications, and geographic location, which may impact the final offer. We share ranges to remain transparent and consistent with pay equity practices.

Any background check or review of criminal history, if applicable to the role, will be conducted only after a conditional offer of employment and in compliance with applicable federal, state, and local laws, including fair-chance hiring requirements.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. We do not use sites like Facebook, Craigslist, or Telegram to recruit or interview potential employees or contractors. If you have been asked to provide any information through any method other than our career portal, please email us at recruitment@davies-group.com

About Davies

We are a specialist professional services and technology firm, working in partnership with leading insurance, highly regulated and global businesses. We help our clients to manage risk, operate their core business processes, transform and grow. We deliver professional services and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation & risk, customer experience, human capital, digital transformation & change management. Our global team of more than 8,000 professionals operate across ten countries, including the UK & the U.S. Over the past ten years Davies has grown its annual revenues more than 20-fold, investing heavily in research & development, innovation & automation, colleague development, and client service. Today the group serves more than 1,500 insurance, financial services, public sector, and other highly regulated clients. Apply Now

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