Claims Specialist - Accident and Health; Medical Stop Loss

Primary Details

• Time Type:
  Full time
• Worker Type:
  Employee
• Location:
  
  USA - MA, Marblehead;
  Atlanta, GA
• Work Arrangement:
  Hybrid or Remote
• The salary range for this role is: $76,K
• Claims Specialist
  - Accident and Health (Medical Stop Loss)

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.

• 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.

Necessary Work Experience includes:

• Moderate relevant experience.

Preferred Work Experience includes:

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

Necessary Qualifications include:

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

The salary range for this role is as stated above. The salary offer will be determined based on the role's complexity, location, and the candidate's professional background, including education and experience. Beyond the base salary, full‑time employees will also be 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 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

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 performed in an office environment with no substantial exposure to adverse environmental conditions. Must be able to remain in a stationary position for extended periods, operate basic office equipment, and lift up to 20 lbs.

• 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

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, disability, or any other legally protected status.