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
AXIS Capital is the Bermuda-based holding company of the AXIS group of companies. AXIS Capital provides specialty insurance and reinsurance...