Claims Specialist providing exceptional service managing complex medical stop loss claims at QBE. Collaborating with stakeholders and maintaining client relationships while ensuring compliance and strategy implementation.
Responsibilities
Provide exceptional claims service to customers by managing complex medical stop loss claims effectively.
Assess policy coverage, investigate, evaluate, and negotiate claims.
Collaborate 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.
Identify and implement strategies to minimise Claims Costs and Leakage.
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.
Requirements
Moderate relevant experience
Experience in an Accident & Health claims department or the insurance industry (preferred)
Experience handling Medical Stop Loss claims (preferred)
Tertiary Degree or equivalent combination of education and work experience (necessary)
Relevant insurance qualifications (necessary)
Benefits
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
Claims Adjuster I responsible for investigating physical damage claims on vehicles. Working under Claims Supervisor to evaluate, settle, or deny claims in Omaha, Nebraska office.
Claims Representative managing insurance claims for Great American Insurance Group. Evaluating liability and negotiating settlements while working in a hybrid model from Cincinnati, OH.
Claims Representative handling entry - level insurance claims at Auto - Owners Insurance. Investigating, evaluating, and settling claims under close supervision in a merit - based work - from - home program.
Claims Processor at Highmark overseeing claims adjustments and inquiries. Responsible for processing complex claims and ensuring timely resolution of payment determinations.
Workers Compensation Claims Adjuster III managing complex claims at AvonRisk. Reports to Claims Supervisor and oversees assigned inventory with a focus on professional growth and support.
Claims Adjuster managing complex indemnity claims at AvonRisk. Collaborating with teams to ensure accurate claim management and compliance with legal requirements.
Claims Adjuster managing complex workers' compensation claims for AvonRisk. Ensuring timely and effective case management with a focus on solutions and collaboration.
Disability Claims Analyst at RBC Insurance evaluating disability claims and communicating with clients. Collaborating with cross - functional teams and managing high - volume cases.
Disability Claims Specialist evaluating disability claims at RBC Insurance. Collaborating across teams to ensure excellent client service and effective claims management.
Multi - Line Claims Adjuster handling high - value liability, property, and automobile claims for municipal clients. Engaging with attorneys and managing litigation from start to finish.