AVP, Accident and Health Claims
AXIS Insurance - Princeton, NJ

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This position provides the highest level of claims handling expertise and supervision for all of the direct accident and health claims, both claims adjudicated in-house and by third party administrators. Serves as the main point of contact for third party administrators and provides technical advice and assistance to the underwriters.

Key Responsibilities & Duties:

  • On-boarding and auditing of third party administrators.
  • Conduct due diligence of potential third party administrators.
  • Create and monitor oversight procedures for third party administrators.
  • Maintain guidelines for the processing of accident insurance claims.
  • Review claims exceeding third party administrator threshold.
  • Document system processes.
  • Process claims that are not administered by third party administrators.
  • Develop cost containment protocols.
  • Coordinate with global colleagues to create claims “best practices.”
  • Process claim files received from third party administrators and create a reconciliation process.
  • Develop expertise in the system for maintaining claim data and make suggested changes and improvements.
  • Review claim information to spot trends and anomalies and follow up on such items.
  • Communicate with underwriting, actuarial and product development regarding claim trends.
  • Producing and reviewing reports for management.
  • Liaison with North American Insurance business unit regarding claim related issues and to provide feedback on policy forms and claims administrators.
  • Other duties as assigned.

Required Education/Training & Experience:

  • Prior 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.
  • Ten to fifteen years of claim handling experience with five years managing accident medical or health claims.

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.

Indeed - 13 months ago - save job - block
About this company
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AXIS Capital is the Bermuda-based holding company of the AXIS group of companies. AXIS Capital provides specialty insurance and reinsurance...