Claims Specialist - Accident and Health (Medical Stop Loss)

Claims Specialist - Accident and Health (Medical Stop Loss)

The purpose of this role is to provide exceptional claims service to our Accident & Health Medical Stop Loss customers by managing complex medical stop loss claims effectively. This includes assessing policy coverage, investigating, evaluating, and negotiating claims, as well as collaborating with suppliers and stakeholders while offering technical support.

Responsibilities:

• Support the implementation of the Claims strategy to enable the delivery of overall business targets.
• Maintain current knowledge of insurance guidelines, policy changes, and modifications.
• Maintain good client relationships with insured individuals, agents, service providers, and the general public.
• Provide claim management for various types of insurance claims.
• Identify and implement strategies to minimize Claims Costs and Leakage.
• Respond to client requests following service standards.
• Assist with the negotiation of claims settlements.
• Participate in relevant meetings to share and develop strategy, knowledge, and best practices.
• Identify and resolve issues or anomalies non-compliant with policies and procedures.
• Assist with the daily review of reports and ad hoc reporting.
• Mentor and coach junior staff as required.

Work Experience:

Necessary Work Experience includes:

• Moderate relevant experience.

Preferred Work Experience includes:

• Experience in a MGU or Medical Stop Loss Carrier claims department.
• Experience handling Medical Stop Loss claims.

Qualifications:

Necessary Qualifications include:

• Tertiary Degree or equivalent combination of education and work experience.
• Relevant insurance qualifications

Compensation Package: The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate's professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE's annual discretionary bonus plan based on business and individual performance. We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team.

QBE Benefits: We offer a range of benefits to help provide holistic support for your work life, whatever your circumstances. As a QBE employee you will have access to:

• Hybrid Working a mix of working from home and in the office
• 22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis
• Competitive 401(k) program with company match up to 8%
• Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice
• Tuition Reimbursement for professional certifications, and continuing education
• Employee Network and Community QBE actively supports six Employee Networks, and many ways to give back to your community

Why QBE? What if you could have a positive impact at work and in the world?

At QBE, we're enabling a more resilient future for our customers, communities, environment, and for our people. We're building momentum to achieve something significant and know our people are at the center of our success.

Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you'll get to spend every day working with people who are passionate, talented and kind. And our international scale means we're big enough for your ambitions, yet small enough for you to make a real impact.

Join us now, so you can be part of our success and we can be part of yours!

Equal Employment Opportunity: QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; protected veteran status; or disability or any other legally protected status. This position is not eligible for visa sponsorship. Applicants must be authorized to work in the United States on a full-time basis without the need for current or future sponsorship.