Accident and Health Senior Claims Specialist

This is your opportunity to join AXIS Capital – a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry.

At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.

All qualified applicants will receive consideration for employment without regard to any protected characteristic, including age, color, disability, ethnicity, gender identity, marital status, national origin, pregnancy, race, religion, sex, sexual orientation, veteran status, or any basis prohibited by the laws that govern its operations.

Accident and Health Senior Claims Specialist

This position provides senior claims handling expertise for all product lines of the Accident and Health division, claims oversight of Third-Party Administrator (TPAs) and MGUs. Primary products include but are not limited to: Leisure Travel, Accident Medical, Pet, Line of Duty, Limited Medical Benefits, Critical Illness, Vision, Dental and Employer Stop Loss.

What will you do in this role?

• Annual and desk auditing of Third-Party Administrators, including preparation and presenting audit reports and findings.

• Assists in the due diligence audit of potential Third-Party Administrators and the subsequent on-boarding of the TPA

• Monitors oversight procedures for Third-Party Administrators

• Assists in the maintenance of the guidelines for the processing of specialty accident and health insurance claims

• Reviews claims exceeding Third-Party Administrator threshold, second level appeals, coordinates responses to complaints and attorneys, as well as carrier reviews and benefit clarifications

• Process larger more complex claims that are administered by Third-Party Administrators or MGU

• Obtains, collates, and reviews data from monthly TPA reporting packages for trends and seeks out corrective action plan when required.

• Communicate with underwriting, actuarial and product development regarding claim trends

• Producing and reviewing reports for management.

• Lead special projects where planning time horizon is several months or more

About You:

We encourage you to bring your own experience and expertise to the table, so while there are some qualifications and experiences, we need you to have, we are open to discussing how your individual knowledge might lend itself to fulfilling this role and help us achieve our goals.

What you need to have:

• Prior special Accident and Health insurance claim management experience required, including substantial experience with medical claims and cost containment.

• Prior experience auditing and reviewing Third-Party Administrators

• Knowledge of ERISA and state claim handling requirements

• Exposure evaluation and reserving skills

• Bachelor’s degree or equivalent industry experience required.

• Insurance designation preferred

• Three to five years of A&H claim handling experience

What we prefer you to have:

• Highly proficient in Microsoft Office suite applications (Outlook, Word, Excel, and PowerPoint)

• Ability to analyze data and draw conclusions from data

• Excellent writing, negotiation, communication, and interpersonal communication skills

• Demonstrated ability to work in a team, interact well with others, meet deadlines, and successfully perform in a changing work environment. This position’s working relationships entail frequent interaction with all departments of the company as well as external business partners.

Role Factors:

Preferred candidates will be able to commute to an AXIS office 3 days a week.

Travel several times a year within the US and Canada for on-site TPA audits

What we offer:

For this position, we currently expect to offer a base salary in the range of $104K to $138K. Your salary offer will be based on an assessment of a variety of factors including your specific experience and work location.

In addition, you will be offered competitive target incentive compensation, with awards based on overall corporate and individual performance. On top of this, you will be eligible for a comprehensive and competitive benefits package which includes medical plans for you and your family, health and wellness programs, retirement plans, tuition reimbursement, paid vacation, and much more.  Where this role is based in the United States of America, this role is exempt for FLSA purposes.