Senior Claims Specialist - Accident & Health; Medical Stop Loss

Primary Details

• Time Type:
  Full Time
• Worker Type:
  Employee

Provide exceptional claims service to customers by managing complex claims effectively. This includes assessing policy coverage, investigating, evaluating, and negotiating intricate claims, collaborating with suppliers and stakeholders, and offering senior technical guidance and support.

• Provide technical guidance and analysis for complex and high-value claims.
• Assist in implementing and maintaining claims management strategies.
• Maintain comprehensive knowledge of insurance guidelines and policies.
• Build and maintain relationships with stakeholders.
• Manage a portfolio of complex or high-value claims.
• Act as an escalation point for customer complaints.
• Provide senior technical expertise and mentoring for team development.
• Engage with the team to encourage partner relationships.
• Support process improvement through negotiation and dispute resolution.

Preferred Work Experience includes:

• Relevant experience in classes.
• Management of complex and/or high value claims.
• Involvement with relevant industry groups

Preferred Qualifications include:

• Tertiary Degree or equivalent combination of education and work experience.

The salary range for this role is $88,000–145,000. Base salary will be decided based on the role's complexity, location, and the candidate's professional background. Eligible for QBE's annual discretionary bonus plan based on business and individual performance.

• 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 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

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, related medical conditions, protected veteran status, 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.

Infrequent (approximately 1–4 trips annually)

General office jobs:
Work is generally performed in an office environment without substantial exposure to adverse conditions. Must be able to remain in a stationary position for extended periods. Must operate basic office equipment including telephone, headset, and computer, and lift up to 20 lbs.

Analytical Thinking, Claims Settlement, Coaching, Critical Thinking, Detail‑Oriented, Insurance Claims Management, Insurance Policies, Intentional collaboration, Managing performance, Problem Solving, Process Improvements, Regulatory Compliance, Risk Management, Stakeholder Management, Technical Support.

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 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.