Claims Director

Our Story

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.

What’s in Store

Davies Insurance Services is looking for a Claims Director (Aggregate Auditor) for the Accident & Health Audit Solutions division to audit Aggregate Stop Loss Claims.  The Accident and Health Audit Solutions division conducts approximately 100 audits annually involving the medical employer stop loss, captive, managed care, and life and disability markets.  The audits are of varying nature including stop loss (Aggregate & Specific), TPA, MGU/carrier, premium, and life and disability.  This role will be a key part of the team, working within a global professional services and technology firm that prides itself on providing the highest standards of service to its clients. You will be responsible for examining and analyzing claims data to ensure accuracy, compliance, and completeness. You will conduct comprehensive audits of aggregate claims, identifying discrepancies, and providing recommendations for improvement. 

To be successful in this role, you must have a keen eye for detail, strong analytical skills, and extensive knowledge of insurance claims processes and regulations. The ideal candidate will have the appropriate experience and demeanor to work independently in reviewing claims, underwriting and premium administrations at the reinsurance level. You must be proactive and take initiative as this a full-time, home-based role. 

Key responsibilities include: 

• Be accountable for independently performing timely and detailed aggregate claim audits to ensure accuracy, compliance with regulations, and adherence to company policies
• Collaboratively work to assist lead auditors on high-level audit assignments
• Draft audit reports with accuracy
• Communicate with clients, third-party administrators, and brokers in requesting required information
• Develop and implement strategies to optimize the audit process and improve efficiency
• Analyze claims data to identify patterns, discrepancies, and areas for improvement. Use statistical methods to validate findings.
• Prepare and present detailed reports on audit findings, including identified issues, potential risks, and recommended corrective actions.
• Identify discrepancies, trends, and areas for improvement in claims processing
• Ensure all claims are handled in accordance with regulatory requirements and company policies
• Stay current with changes in laws and regulations affecting aggregate stop loss claims
• Implement necessary changes to policies and procedures to maintain compliance
• Work closely with other departments, such as Underwriting, Legal, and Finance, to ensure seamless claims processing
• Act as a liaison between the claims department and external auditors, reinsurers, and clients
• Build and maintain strong relationships with key stakeholders
• Support company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together
• Perform other duties as assigned

This is a full-time, home-based role that may require some travel.

Your Expertise, Skills, and Abilities

• Bachelor’s Degree and/or minimum of 5 years’ experience in industry audit or stop loss claims experience
• Intermediate level MS Word and MS Excel experience
• Ability to work in a team environment, maintain a positive attitude, and to collaborate with Proactive, independent, and takes initiative with consistent follow through
• Superior time management skills with capability of working with and meeting deadlines
• Exceptional capability to multitask and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment
• Excellent interpersonal skills to effectively communicate across the organization 
• Knowledge and experience with auditing of stop loss claims
• Exceptional organizational leadership, communication skills and overall project management
• Intermediate level MS Word and MS Excel experience
• Successful experience in building and maintaining strong relationships, both with clients and colleagues 

Benefits

At Davies North America, we are dedicated to supporting the well-being and future of our qualifying employees. Our comprehensive benefits package includes:

• Medical, dental, and vision plans to ensure your health and that of your family.
• A 401k 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.

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