Senior Claims Specialist

Axis • Red Bank, NJ • 2h ago

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 across all product lines within the Accident and Health division, including claims adjudicated both in-house and by Third-Party Administrators (TPAs) and MGUs.

Primary products include, but are not limited to: Managed Care, HMO, Medical Excess, Provider Excess, and Employer Stop Loss. Additional Specialty products include Leisure Travel, Excess Accident, Pet, Firefighter Line of Duty, Limited Medical Benefits, and Voluntary Benefits (Accident Medical, Critical Illness, Vision, Dental, and Short-Term Disability).

What will you do in this role?

Strong understanding of HMO, excess medical, stop-loss, and high-severity claims

Knowledge of medical cost containment strategies and provider/network dynamics

Understanding and handling of Specialty A&H products

Conduct annual and desk audits of MGUs and TPAs, including preparation and presentation of audit findings and reports

Assist with due diligence reviews of prospective TPAs and support onboarding processes

Monitor and enforce oversight procedures for MGUs and TPAs

Support the development and maintenance of guidelines for processing specialty A&H claims

Review claims exceeding MGU and TPA authority thresholds, including second-level appeals

Coordinate responses to complaints, attorneys, carrier reviews, and benefit clarifications

Provide oversight of Provider Excess structures and HMO/Managed Care provider reimbursement

Gather, analyze, and interpret monthly reporting data to identify trends and implement corrective action plans as needed

Partner with underwriting, actuarial, and product development teams to communicate claim trends and insights

Produce and review reports for management

Lead special projects with multi-month planning horizons

About You:

We encourage you to bring your unique experience and expertise. While we have identified key qualifications, we value diverse backgrounds and perspectives that can contribute to success in this role and the broader goals of the organization.

What you need to have:

Prior experience with MGU oversight, including Stop Loss, Provider Excess, and Managed Care claims

Strong Accident & Health claims management experience, including medical claims and cost containment

Experience auditing and reviewing Third-Party Administrators

Knowledge of ERISA and applicable state claims handling requirements

Exposure evaluation and reserving experience

Bachelor's degree or equivalent industry experience

Insurance designation preferred

4-6 years of experience with stop-loss, HMO managed care, excess provider, captive programs including A&H products

What we prefer you to have:

Highly proficient in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint)

Strong analytical skills, including ability to interpret data; Power BI experience a plus

Excellent written, negotiation, and communication skills

Proven ability to work collaboratively, manage deadlines, and operate effectively in a dynamic environment

Comfortable interacting across all levels of the organization and with external business partners

Role Factors:

Preferred candidates will be able to commute to an AXIS office three days per week

Travel several times per year within the U.S. and Canada for on-site TPA audits

What do we offer:

Base salary range: $104K - $138K (based on experience and location)

Competitive incentive compensation tied to corporate and individual performance

Comprehensive benefits package including:

o Medical, dental, and vision plans

o Health and wellness programs

o Retirement plans

o Tuition reimbursement

o Paid time off and additional benefits

Where this role is based in the United States, it is classified as exempt for FLSA purposes.

Axis

Go to Apply

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