Senior Claims Specialist

AXIS (AXIS Capital) • Short Hills, NJ

1d • Hybrid

About The Position

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 race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family or parental status, or any other characteristic protected by law. Accommodation is available upon request for candidates taking part in the selection process. Accident and Health Senior Claims Specialist This position provides senior claims handling expertise for all product lines of the Accident and Health division, both claims adjudicated in-house and by Third-Party Administrators (TPAs). Primary products include but are not limited to: Employer Stop Loss, Leisure Travel, Accident Medical, Pet, Line of Duty, Limited Medical Benefits, Accident Medical, Critical Illness, Vision, Dental and Short-term Disability.

Requirements

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

Nice To Haves

• Insurance designation preferred
• 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.

Responsibilities

• 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 not administered by Third-Party Administrators
• 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

Benefits

• comprehensive and competitive benefits package which includes medical plans for employees and their families
• health and wellness programs
• retirement plans
• tuition reimbursement
• paid vacation

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Number of Employees: 501-1,000 employees