Claims Specialist - Accident & Health

Claims Specialist - Accident and Health

The Opportunity

The purpose of this role is to provide exceptional claims service to customers by managing complex medical stop loss claims effectively. This includes assessing policy coverage, investigating, evaluating, and negotiating claims, as well as collaborating with suppliers and stakeholders while offering technical support.

Responsibilities:

• 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.
• Provide claim management for various types of insurance claims.
• Identify and implement strategies to minimise Claims Costs and Leakage.
• Respond to client requests following service standards.
• 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.

Work Experience:

Necessary Work Experience includes:

• Moderate relevant experience.

Preferred Work Experience includes:

• Experience in an Accident & Health claims department or the insurance industry.
• Experience handling Medical Stop Loss claims.

Qualifications:

Necessary Qualifications include:

• Tertiary Degree or equivalent combination of education and work experience.
• Relevant insurance qualifications

Skills:

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.