TPA Examiner

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 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
• Maintain adequate reserves for life of claim utilizing reserve worksheets as guides and applying Davies Claims North America reserving philosophy
• 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 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 Property and Liability claims handling
• Insurance industry knowledge and experience

Knowledge, Skills, and Abilities

• Proactive, independent, and takes initiative with consistent follow through
• Superb communication skills, verbal and written, conducted in a timely manner
• Superior time management skills with capability of working with and meeting deadlines
• Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment
• Excellent team player with interpersonal skills
• High level attention to detail and problem-solving skills
• Capable of working collaboratively and independently with minimal supervision
• Exhibit discretion with sensitive and confidential information
• Display a comfort level working with key people at all levels within an organization

Essential Requirements

• Must have US work rights
• Must speak English
• 1-2 years of relevant experience handling full adjustment 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

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 is 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 teammates have moved across into brand new positions to further develop their ideas/projects!

Benefits

• Medical, dental, and vision plans
• 401k plan with employer matching
• Paid Time Off, Sick Leave, and Paid Holidays
• Life insurance, short term, and long-term disability plans
• Amazing Executive and Senior leadership as well as fabulous teammates

Position Type, Work Environment and Physical Demands

This role is a full time, home-based, salaried position that predominantly operates remotely from a professional home-based 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.

Location

Davies Claims North America is currently able to support employees residing in the following US locations: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Nevada, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, and Virginia (except for D.C.). If you live in—or are willing to relocate at your own expense to—any of the listed locations, we look forward to your application! If there is a required or preferred location for an open role, it will be listed in the job description. Should your state not be listed, please visit https://davies-group.com/location/ to locate a subsidiary near you.

Application Information

Application deadline: March 25th, 2024