Claims Specialist - Accident and Health

QBE Americas, Inc.; Markham; Hybrid; USD 75,000 - 128,000; Full time

Job summary

An established industry player is seeking a Claims Specialist to manage a diverse portfolio of accident and health claims. In this dynamic role, you will conduct thorough investigations, negotiate settlements, and collaborate with various teams to ensure timely resolutions. This position offers a hybrid work model, competitive salary, and a range of benefits, including paid family leave and tuition reimbursement. Join a passionate team dedicated to making a meaningful impact while fostering an inclusive workplace culture that values diversity and collaboration.

Benefits

22 weeks paid family leave

Competitive 401(k) with up to 8% match

Well-being programs

Tuition reimbursement

Qualifications

• Minimum of 3 years relevant experience in claims management.
• Bachelor's Degree or equivalent experience required.

Responsibilities

• Manage a portfolio of moderately complex claims and conduct loss investigations.
• Negotiate claims settlements and inform stakeholders about resolution processes.

Skills

Analytical Thinking

Claims Settlement

Negotiation

Risk Management

Customer Service

Problem Solving

Stakeholder Management

Collaboration

Education

Bachelor's Degree

Tools

Microsoft Office

Database Systems

Job description

Primary Details

Time Type: Full time
Worker Type: Employee

Claims Specialist - Accident and Health

• Location: USA - MA - Marblehead
• Work Arrangement: Hybrid
• The salary range for this role is: $75,000 - $128,000

The Opportunity

Manage a portfolio of moderately complex claims by conducting loss investigations, evaluations, and settlements on moderate to high-level claims for assigned lines of business. Ensure timely and accurate reserves. Collaborate effectively with Underwriting, Actuary, Legal, and Risk teams. Conduct and coordinate loss investigations within authority limits to provide accurate facts for disposition.

Your New Role

• Administer insurance coverage to moderately complex claims through loss investigations, analyzing factual data, interpreting policies, and applying legal and technical knowledge for timely resolution.
• Negotiate claims settlements by collaborating with experts and involved parties, recommending reserve modifications, and communicating solutions to mitigate risks and coverage conflicts.
• Inform stakeholders about claims resolution processes by summarizing factual information and managing documentation to ensure clarity on individual claims.
• Build strong relationships by reporting on claims strategies, fostering understanding of Claims operations, and promoting collaboration.
• Support workflow efficiency by documenting progress, referring high-risk exposures outside authority, and seeking operational improvements.
• Contribute to a positive work environment by demonstrating cultural values, encouraging accountability, diversity, inclusion, flexibility, continuous improvement, collaboration, creativity, and fun.

Required Education

Bachelor's Degree or equivalent experience.

Required Experience

Minimum of 3 years relevant experience.

Required Licenses/Certifications

Obtain and maintain state adjusting licenses as needed.

Preferred Competencies/Skills

• Effective communication to influence decision makers.
• Conflict mediation and resolution skills.
• Ability to analyze relevant information and assess impact.
• Maintain integrity of claims data and evidence.
• Utilize multiple resources for data analysis.
• Leverage technical knowledge for cost-effective decisions.
• Encourage open communication and knowledge sharing.
• High attention to detail.
• Strong planning, prioritization, and organizational skills.

Preferred Experience

• Experience in claims department or insurance industry.
• Knowledge of contract interpretation and negotiation.
• Experience in brokerages, third-party administration, risk management, or legal roles.

Preferred Knowledge

• Claims administration best practices.
• Insurance products and services.
• Relevant laws and regulations across jurisdictions.
• Market trends and organizational strategies.
• Proficiency in Microsoft Office and database systems.

Compensation Package

The salary range is as specified. Offers depend on role complexity, location, and candidate background. Employees are eligible for an annual discretionary bonus based on performance.

Benefits

• Hybrid work model (home and office).
• 22 weeks paid family leave, gender-equal.
• Competitive 401(k) with up to 8% match.
• Well-being programs including guided meditations and rebates for fitness.
• Tuition reimbursement for continuing education and certifications.

Why QBE?

We aim to build a resilient future for customers, communities, the environment, and our people. Join us to work with passionate, talented individuals and make a meaningful impact.

Learn more: QBE LinkedIn

Commitment to Diversity

We foster an inclusive workplace where everyone is valued. Assistance during recruitment is available upon request.

Equal Employment Opportunity

QBE is committed to equal opportunity employment and complies with applicable legislation.

Skills

Analytical Thinking, Business Process Improvements, Claims Settlement, Critical Thinking, Customer Service, Insurance Analysis, Insurance Claims Management, Insurance Policies, Collaboration, Managing Performance, Negotiation, Problem Solving, Risk Management, Sound Judgment, Stakeholder Management

How to Apply

Click "Apply" and follow the steps to submit your application.