Title: Senior Accident & Health Claims Specialist
Location: Remote (Occasional travel required)
Job Type: Full-time
Industry: Insurance/Reinsurance
About Us:
Join a leading insurance and reinsurance provider, offering innovative solutions in Accident & Health claims. We're seeking an experienced Senior Accident & Health Claims Specialist to join our team. This role will involve managing claims, collaborating with vendors, and ensuring alignment with our business goals.
Key Responsibilities:
- Review and process Accident & Health claims; interpret reinsurance contracts and policy language.
- Analyze claim eligibility, coverage issues, and ensure proper provisions and limits.
- Work with vendors, brokers, and clients to resolve claims issues.
- Lead claims committees, report on large losses, and present recommendations to management.
- Maintain accurate claim records and ensure timely reimbursements.
- Participate in industry events and ongoing professional development.
Requirements:
- 10+ years of experience in Accident & Health claims (HMO reinsurance, Stop Loss, Managed Care).
- Proficiency with reinsurance treaties, policy interpretation, and Microsoft Excel.
- Strong analytical, problem-solving, and communication skills.
- Ability to work independently and collaboratively across teams.
- Bachelor's Degree or equivalent experience in insurance, reinsurance, or financial services.
