Claims Specialist, Accident and Health (A&H) (Princeton)

Accident And Health 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 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.

Position Summary :

This position provides claims handling expertise for all of the accident and health claims, both claims adjudicated in-house and by third party administrators (TPAs). Serves as a point of contact for third party administrators, responsible for audits of the TPAs and review of claims over thresholds.

Key Responsibilities & Duties :

• Auditing of third-party administrators, including preparation of audit reports and findings
• Assists in the due diligence of potential third-party administrators and subsequent on-boarding of the TPA
• Monitors oversight procedures for third party administrators
• Assists in the maintenance of the guidelines for the processing of accident insurance claims
• Reviews claims exceeding third party administrator threshold
• Assists in the documentation of system processes
• Process claims that are not administered by third party administrators
• Assists in the development of cost containment protocols
• Process claim files received from third party administrators and ensures appropriate reconciliation
• Develops expertise in the system for maintaining claim data
• Review claim information to spot trends and anomalies and follow up on such items
• Communicate with underwriting, actuarial and product development regarding claim trends and assists in the development and reporting or claim metrics
• Producing and reviewing reports for management.
• Other duties as assigned

Required Education / Training & Experience :

Other Desired Skills & Characteristics :