Tpa Claims Examiner - Lakewood Ranch, United States - Davies Claims North America

Davies Claims North America

Verified Company

Lakewood Ranch, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

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 threepoint 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 highquality 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

12 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