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
Property Claims Representative managing a personal caseload of property claims at Hastings Insurance. Investigating and resolving claims while providing customer support.
STD Claims Examiner II making accurate claim decisions for Short Term Disability claims. Collaborating with team members in a hybrid work environment from South Portland, ME.
Claims Specialist managing high exposure casualty and specialty claims for Hamilton Select. Responsible for mentoring new adjusters and ensuring compliance with corporate guidelines.
LMI Claims Specialist assessing and managing complex LMI claims for QBE’s insurance team. Delivering high - quality outcomes while providing technical expertise and compliance oversight.
Workers Compensation Claims Representative managing claims independently with minimal oversight. Conducting thorough investigations and negotiating settlements for insured parties in a hybrid work environment.
Claims Specialist I handling auto and general liability claims at AIG. Investigating, evaluating, and resolving claims with a focus on customer service and timely resolution.
Aviation Claims Analyst IV responsible for handling aviation claims at AIG. Involves adjusting aircraft physical damage claims and managing stakeholders in the aerospace sector.
Senior Claims Adjuster managing high exposure casualty and specialty claims for Hamilton. Responsible for mentoring staff, analyzing claims, and ensuring compliance with corporate guidelines.
P&C Claims Representative providing high - level customer service in processing property and casualty insurance claims. Responsibilities include client liaison, documentation, and claims management.
Bilingual Disability Claims Analyst in Group Insurance delivering expert client service and managing risk strategies. Collaborating with diverse teams to ensure successful claim outcomes and stakeholder communication.