Claim Manager Assistant I (Remote)
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Job Summary
Our Story
Imagine being part of a team thats not just shaping the future but actively driving it. At Davies North America were at the forefront of innovation and excellence blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group we help businesses navigate risk optimize operations and spearhead transformation in the insurance and regulated sectors.
Whats in Store
The Claim Manager Assistant I (CMA I) is responsible for handling and processing a variety of incoming and outgoing communications 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
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
Benefits
At Davies North America we are dedicated to supporting the wellbeing 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
- Timeoff policies including Discretionary Time Off (DTO) for exempt employees and Paid Time Off (PTO) for nonexempt employees
- Paid holidays
- Life insurance and shortterm and longterm 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 employees 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.
Diversity and Inclusion
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.
Compensation Transparency:
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.
Background Check & Fair Chance Compliance
Compensation Transparency:
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.
Background Check & Fair Chance Compliance
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 fairchance hiring requirements.
Massachusetts Notice
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.
Massachusetts Notice
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.
Required Experience:
Manager
