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

Description

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.

Overview

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.

Key Responsibilities

• 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 roundtables 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 calls and meetings in the file notes, and making sure that all necessary fields have been completed and updated accurately and timely. Monitor the progress of claims, meet established deadlines, and ensure compliance with regulatory requirements.
• Continuous Learning: Stay updated on insurance industry trends, regulations, and emerging technologies relevant to claim adjusting. Participate in training programs and professional development activities to enhance knowledge and skills.

Skills, knowledge & expertise

• Bachelor's degree (or equivalent work experience) Juris Doctor and admission to a relevant State Bar and remain in good standing.
• Proven experience as a Claim Adjuster or in a similar role within the insurance industry.
• In-depth knowledge of insurance policies, coverage, and claims procedures.
• Familiarity with legal and regulatory requirements pertaining to claims handling.
• Strong analytical and problem‑solving skills, with attention to detail.
• Excellent verbal and written communication skills.
• Ability to negotiate and resolve conflicts effectively.
• Proficient in using claim management software and digital tools.
• Demonstrated ability to work independently and meet deadlines.
• Relevant certifications (e.g., claims adjuster licenses) and willingness to obtain additional licenses, if needed.

Benefits

• Medical, dental, and vision plans to ensure your health and that of your family.
• A 401(k) plan with employer matching to help you build a secure financial future.
• Our time‑off policies, including Discretionary Time Off for exempt employees and Paid Time Off (PTO) package for non‑exempt employees, reflect our commitment to promoting a healthy work environment.
• Paid holidays.
• Life insurance and both short‑term and long‑term disability plans, providing essential financial protection for you and your loved ones.

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.