Senior Claims Specialist - Accident & Health Claims

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 :

AXIS is seeking a Senior Claims Specialist to join our North America Accident & Health Claims team reporting to the Head of Accident and Health Claims.

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 : Limited Medical Benefits such as Hospital Indemnity, Accident Medical, Critical Illness, Vision, Dental and Short-term Disability.

Accidental death and accident medical type coverages, disability claims, business travel, leisure travel, accident and Pet Insurance.

Preferred candidates will be able to commute to an AXIS office, we are a hybrid work environment 3 days a week.

Key Responsibilities & Duties :

Auditing of Third-Party Administrators, including preparation and presenting audit reports and findings. May be part of a Claims Audit Team or travel to assess claims

Conducts monthly desk audits of key Third-Party Administrators

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

Assists in the development of cost containment protocols

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

Other duties as assigned

Required Education / Training & Experience :

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

Participates in professional / market associations to gain expertise and network

Other Desired Skills & Characteristics :

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

Ability to work in a fast paced, dynamic organization

Ability to analyze data and draw conclusions from data

Excellent writing skills

Excellent negotiation, communication, and interpersonal communication skills

Creative with the ability to "think outside the box" to effectively solve problems

Demonstrated ability to work in a team, interact well with others, meet deadlines, and successfully perform in a changing work environment

Relationships :

This position's working relationships entail frequent interaction with all departments of the company (actuary, compliance, finance, operations, underwriting, etc.

as well as external business partners.

For this position, we currently expect to offer a base salary in the range of $95,000 - $130,000 (New Jersey). The specific salary offer will be based on an assessment of a variety of factors including the experience of the successful candidate and their work location.

In addition, all employees are eligible for competitive incentive targets, with awards based on overall corporate and individual performance.

On top of this, we offer a comprehensive and competitive benefits package which includes medical plans for employees and their families, health and wellness programs, retirement plans, tuition reimbursement, paid vacation, and much more.