About this opportunity
Axis Capital lists this Accident and Health Senior Claims Specialist (Provider XS/ESL) opportunity in short hills, New Jersey. Review the employer’s description below for duties, qualifications and application requirements.
Job description
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: medical, dental, and vision plans; health and wellness programs; retirement plans; tuition reimbursement; paid time off and additional benefits
Worksite address
short hills, NJ, 07078, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.