Senior Claims Specialist - Accident and Health
QBE The Americas - New York City, NY
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Primary DetailsTime Type: Full timeWorker Type: EmployeeThe OpportunityThe role will manage a portfolio of complex claims by conducting loss investigations, evaluations and settlements on moderate to high level claims for the Accident and Health business unit. Assures timely and accurate reserves. Effective communication and collaboration with Underwriting, Actuary, Legal and Risk. Working within specific limits and authority, conduct and coordinate loss investigations on technically complex claims to provide accurate facts for disposition.Primary Responsibilities Implement the administration of insurance coverage to complex claims by conducting loss investigations, analyzing factual information, interpreting insurance policies and applying legal and technical knowledge to independently resolve claims files in a timely mannerNegotiate claims settlements by collaborating with subject matter experts and involved parties, recommending appropriate reserve modifications for assigned claims and communicating solutions to mitigate risks and coverage conflicts and achieve cost effective outcomesInform internal and external stakeholders on claims resolution processes by summarizing factual information, reporting out-of-scope, specialized exposures and accurately managing documentation of assigned claims to ensure effective communication of current state for individual claims portfolioFacilitate strong working relationships by communicating across the organization and reporting on approved, cost-effective claims strategies to ensure understanding of Claims operations and encourage a collaborative approach to enhancing the businessParticipate in claims specialist onboarding by sharing technical knowledge, recommending solutions to complex, escalated issues, training on department processes and procedures and demonstrating application of best practices to assist in development of new team membersSupport claims workflow efficiency by accurately documenting portfolio progress, referring high risk exposures outside authority levels and seeking opportunities that enhance operational knowledge to ensure achievement of individual and department objectivesEnsure correct, cohesive and efficient customer solutions by collaborating and supporting team in decision-making to foster partnered approach to claims undertakingsEstablish a personal, empathetic connection with customers by providing comprehensive communication to ensure thorough understanding of available claims deliverablesContribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value 'can do' people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and funRequired Education Bachelor's Degree or equivalent combination of education and work experienceRequired Experience 5 years relevant experiencePreferred Competencies/Skills Utilize effective communication to effectively influence and persuade decision makers; understand the needs and goals of customers and actively look for ways to meet themMediate and resolve conflict using a logical approachIdentify relevant information and understand it's impactMaintain integrity of claims portfolio and evidenceUse multiple resources to gather and analyze significant dataLeverage technical knowledge to make cost-effective decisionsEncourage open communication, cooperation and knowledge sharingHigh attention to detailImplement planning to organize, prioritize and measure individual workPreferred Experience Experience in a claims department or the insurance industryExperience handling workers compensation claimsPreferred Licenses/Certifications Registered Nurse (RN)Preferred Knowledge Working knowledge of claims administration best practices and proceduresWorking knowledge of insurance products and servicesBroad understanding of relevant laws and regulations across multiple jurisdictionsBasic understanding of market trends and organizational strategiesWorking knowledge of Microsoft Office Suite, general computer software and database systemsbout QBEWe can never really predict what's around the corner, but at QBE we're asking the right questions to enable a more resilient future by helping those around us build strength and embrace change to their advantage.We're an international insurer that's building momentum towards realizing our vision of becoming the most consistent and innovative risk partner.And our people will be at the center of our success. We're proud to work together, and encourage each other to enable resilience for our customers, our environment, our economies and our communities.With more than 12,000 people working across 27 countries, we're big enough to make a real impact, but small enough to provide a friendly workplace, where people are down-to-earth, passionate, and kind.We believe this is our moment: What if it was yours too?Your career at QBE - let's make it happenOnly - Travel Frequency Occasional (approximately 5-10 trips annually)US Only - Physical Demands General office jobs: Work is generally performed in an office environment in which there is not substantial exposure to adverse environmental conditions. Must have the ability to remain in a stationary position for extended periods of time. Must be able to operate basic office equipment including telephone, headset and computer. Incumbent must be able to lift basic office equipment up to 20 lbs.US Only - Disclaimer To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities.Global Disclaimer 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 to be 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 clusion of DiversityAt QBE, we are deeply committed to fostering an inclusive workplace where each person is valued and respected for their authentic selves. If you require any assistance, such as alternative interview accommodations during the recruitment process, please do not hesitate to inform our Talent Acquisition pensationBase pay offered will vary depending on, but not limited to education, experience, skills, geographic location and business needsAnnual Salary Range: $70,000 - $104,000AL, AR, AZ, CO (Remote), DE, FL, GA, IA, ID, IL (Remote), IN, KS, KY, LA, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NV, OH, OK, OR, PA, SC, SD, TN, TX (Remote, Plano), UT, VA, VT, WI, WV and WY Annual Salary Range: $77,000 - $115,000CA (Remote, Fresno, Irvine and Woodland), Greenwood Village CO, CT, Chicago IL, MA, MD, NY (Remote), RI, Houston TX and WA Annual Salary Range: $87,000 - $131,000San Francisco CA, NJ and New York City NYBenefit HighlightsYou are more than your work - and QBE is more than a workplace, which is why QBE provides you with the benefits, support and flexibility to help you concentrate on living your best life personally and professionally. Employees scheduled over 30 hours a week will have access to comprehensive medical, dental, vision and wellbeing benefits that enable you to take care of your health.We also offer a competitive 401(k) contribution and a paid-time off program. In addition, our paid-family and care-giver leaves are available to support our employees and their families. Regular full-time and part-time employees will also be eligible for QBE's annual discretionary bonus plan based on business and individual performance.At QBE, we understand that exceptional employee benefits go beyond mere coverage and compensation. We recognize the importance of flexibility in the work environment to promote a healthy balance, and we are committed to facilitating personal and professional integration for our employees. That's why we offer the opportunity for hybrid work arrangements.If this role necessitates a hybrid working model, candidates must be open to attending the office 8-12 days per month. This approach ensures a collaborative and supportive work environment where team members can come together to innovate and drive success.How to Apply:To submit your application, click 'Apply' and follow the step by step process.Equal Employment Opportunity:QBE is an equal opportunity employer and is required to comply with equal employment opportunity legislation in each jurisdiction it operates.Equal Employment Opportunity The companies of QBE North America are committed to equal employment opportunities. All qualified applicants will receive consideration for employment without regard to age, disability, marital or parental status, national origin, citizenship, race, color, religion, sex, sexual orientation, or veteran status. All personal information contained in this application will be kept confidential as required by law. Minimum Salary: 31200.00 Maximum Salary: 31200.00 Salary Unit: Yearly
Created: 2024-09-23