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Claims Specialist - Accident and Health (Medical Stop Loss)

QBE -
Marblehead, MA

Apply Now

Job Details

Full-time

Benefits

Tuition reimbursement
401(k) matching
Gym membership

Qualifications

Mid-level

Full Job Description

Primary Details

Time Type: Full time

Worker Type: Employee

Claims Specialist - Accident and Health (Medical Stop Loss)

Location: USA – MA, Marblehead; Atlanta, GA
Work Arrangement: Hybrid or Remote
The salary range for this role is: $76,000-125,500K

The Opportunity

The purpose of this role is to provide exceptional claims service to our Accident & Health Medical Stop Loss customers by managing complex medical stop loss claims effectively. This includes assessing policy coverage, investigating, evaluating, and negotiating claims, as well as collaborating with suppliers and stakeholders while offering technical support.

Responsibilities:

Support the implementation of the Claims strategy to enable the delivery of overall business targets.
Maintain current knowledge of insurance guidelines, policy changes, and modifications.
Maintain good client relationships with insured individuals, agents, service providers, and the general public.
Provide claim management for various types of insurance claims.
Identify and implement strategies to minimise Claims Costs and Leakage.
Respond to client requests following service standards.
Assist with the negotiation of claims settlements.
Participate in relevant meetings to share and develop strategy, knowledge, and best practices.
Identify and resolve issues or anomalies non-compliant with policies and procedures.
Assist with the daily review of reports and ad hoc reporting.
Mentor and coach junior staff as required.

Work Experience:

Necessary Work Experience includes:

Moderate relevant experience.

Preferred Work Experience includes:

Experience in a MGU or Medical Stop Loss Carrier claims department.
Experience handling Medical Stop Loss claims .

Qualifications:

Necessary Qualifications include:

Tertiary Degree or equivalent combination of education and work experience.
Relevant insurance qualifications

Compensation Package: The salary range for this role is provided above. This is the national range for location(s) listed. The salary offer will be decided based on the role's complexity, its location, and the candidate’s professional background, including their education and experience. Beyond the base salary, regular full-time and part-time employees will also be eligible for QBE’s annual discretionary bonus plan based on business and individual performance. We encourage all candidates to apply, even if their salary expectations fall outside of this range, as we are committed to finding the right fit for our team.

QBE Benefits: We offer a range of benefits to help provide holistic support for your work life, whatever your circumstances. As a QBE employee you will have access to:

Hybrid Working – a mix of working from home and in the office
22 weeks of paid leave for family growth, with 12 weeks available to all parents on a gender-equal basis
Competitive 401(k) program with company match up to 8%
Well-being program including holistic wellbeing coaching, gym membership, confidential counselling, financial and legal advice
Tuition Reimbursement for professional certifications, and continuing education
Employee Network and Community – QBE actively supports six Employee Networks, and many ways to give back to your community

To learn more, click here: Benefits | QBE US.

Why QBE? What if you could have a positive impact – at work and in the world?

At QBE, we’re enabling a more resilient future – for our customers, communities, environment, and for our people. We’re building momentum to achieve something significant and know our people are at the center of our success.

Our industry offers interesting and varied careers where you can help people to protect what matters most. As part of the QBE team, you’ll get to spend every day working with people who are passionate, talented and kind. And our international scale means we’re big enough for your ambitions, yet small enough for you to make a real impact.

Join us now, so you can be part of our success – and we can be part of yours!

https://www.linkedin.com/company/qbe-north-america/

QBE is committed to providing reasonable accommodation to, among others, individuals with disabilities and disabled veterans. If you need an accommodation because of a disability to search and apply for a career opportunity with QBE, please inform our Talent Acquisition team to let us know the nature of your accommodation request and your contact information.

Equal Employment Opportunity:

QBE provides equal employment opportunities to applicants and employees without regard to race; color; gender; gender identity; sexual orientation; religious practices and observances; national origin; pregnancy, childbirth, or related medical conditions; protected veteran status; or disability or any other legally protected status.

This position is not eligible for visa sponsorship. Applicants must be authorized to work in the United States on a full-time basis without the need for current or future sponsorship.

Supplementary information

Global Disclaimer:

The duties listed in this job description do not limit the assignment of work. They are not to be construed as a complete list of the duties normally to be performed in the position or those occasionally assigned outside an employee’s normal duties. Our Group Code of Ethics and Conduct addresses the responsibilities we all have at QBE to our company, to each other and to our customers, suppliers, communities and governments. It provides clear guidance to help us to make good judgement calls.

US Only Disclaimer:

To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities.

US Only - Travel Frequency:

Infrequent (approximately 1-4 trips annually)

US Only - Physical Demands:

General office jobs: Work is generally performed in an office environment in which there is not substantial exposure to adverse environmental conditions. Must have the ability to remain in a stationary position for extended periods of time. Must be able to operate basic office equipment including telephone, headset and computer. Incumbent must be able to lift basic office equipment up to 20 lbs.

Skills:

Analytical Thinking, Business Process Improvements, Claims Settlement, Critical Thinking, Customer Service, Insurance Analysis, Insurance Claims Management, Insurance Policies, Intentional collaboration, Managing performance, Negotiation, Problem Solving, Risk Management, Sound Judgment, Stakeholder Management

How to Apply:

To submit your application, click "Apply" and follow the step by step process.

Equal Employment Opportunity:

QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.

Apply Now

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