Sr Claim Representative​/Legal Claims

Sr Claim Representative/Legal Claims –
Davies North America

Department: Claims Administration & Adjusting

Location: Home United States

Compensation: $95,000 - $110,000 / year

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 part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors.

As a Senior Claim Adjuster, you will play a crucial role in the insurance industry by evaluating and processing insurance claims. You will be responsible for investigating claims, assessing damages, determining coverage, and negotiating settlements. Your attention to detail, analytical skills, and ability to communicate effectively with clients and other stakeholders will be vital in ensuring fair and efficient resolution of claims.

This position requires a strong understanding of insurance policies, regulations, and industry standards, and you must complete investigations and claims adjusting in full compliance with any relevant Department of Insurance regulations. All tasks must be done in accordance with authority granted to the Company and you, making sure to obtain carrier or management authority when needed.

• Claim Evaluation: Investigate and evaluate insurance claims to determine coverage, liability, and potential damages. Review policy terms and conditions to assess the validity of claims and ensure compliance with company policies and industry regulations. Prepare coverage letters to insureds that explain the carrier’s coverage position, including any bases for reserving rights or denying coverage.
• Documentation and Reporting: Collect and analyze relevant information, such as photographs and other proof of loss to document the claim. Prepare detailed reports summarizing findings, including coverage analysis, damage assessments, and settlement/reserve recommendations.
• Customer Service: Communicate with claimants, policyholders, and other stakeholders to gather information, address concerns, and provide updates on claim status. Provide exceptional customer service by responding promptly to inquiries and maintaining professional and empathetic communication.
• Implement Program Guidelines and PCM Procedures: Thoroughly understand and follow relevant Program Guidelines that are specific to any programs in which you are involved. To the extent that specific Program Guidelines are not available for a given program, understand and follow PCM Procedures.
• Investigation and Negotiation: Conduct thorough investigations by interviewing involved parties, inspecting damaged property, and reviewing police reports or medical records. Negotiate fair settlements with claimants, adhering to company guidelines, legal requirements, and industry standards. You may be required to attend off‑site investigations, inspections, mediations, meetings, and hearings, as needed.
• Policy Interpretation: Interpret insurance policies and coverage terms to determine the extent of coverage and any applicable exclusions. Advise policyholders and claimants on their rights, obligations, and potential outcomes related to the claim. Draft clear and concise coverage letters to insureds, summarizing the results of the coverage investigation and explaining the decision on coverage, if applicable. Ensure that the coverage letters are accurate, informative, and adhere to carrier guidelines and legal requirements.
• Collaboration: Collaborate with internal units, including management, coverage, and accounting. Attend conference calls, presentations, and round tables with management and the carriers, including being prepared to present claims, your investigation, coverage and participate in discussions of strategy.
• Claims Management System: Maintain accurate and up‑to‑date claim records, utilizing digital systems and databases. This includes attaching all emails and documents to the claims system, maintaining a diary, documenting all phone…