Senior Claims Specialist
Axis Communications
full-time
Posted on:
Location Type: Hybrid
Location: Princeton • New Jersey • United States
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Salary
💰 $95,000 - $130,000 per year
Job Level
About the role
- Annual and desk auditing of Third-Party Administrators, including preparation and presenting audit reports and findings.
- Assists in the due diligence audit of potential Third-Party Administrators and the subsequent on-boarding of the TPA
- Monitors oversight procedures for Third-Party Administrators
- Assists in the maintenance of the guidelines for the processing of specialty accident and health insurance claims
- Reviews claims exceeding Third-Party Administrator threshold, second level appeals, coordinates responses to complaints and attorneys, as well as carrier reviews and benefit clarifications
- Process larger more complex claims that are not administered by Third-Party Administrators
- Obtains, collates, and reviews data from monthly TPA reporting packages for trends and seeks out corrective action plan when required.
- Communicate with underwriting, actuarial and product development regarding claim trends
- Producing and reviewing reports for management.
- Lead special projects where planning time horizon is several months or more
Requirements
- Prior special 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
- Three to five years of A&H claim handling experience
Benefits
- Medical plans for you and your family
- Health and wellness programs
- Retirement plans
- Tuition reimbursement
- Paid vacation
- Competitive target incentive compensation
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
audit reportingclaims processingdata analysiscost containmentexposure evaluationreserving skillsThird-Party Administrator auditingspecialty accident and health insurance claims managementmedical claims management
Soft Skills
communicationleadershiporganizational skillsproject management
Certifications
insurance designation