Claims Specialist, Accident & Health — Hybrid

QBE North America; Marblehead (MA); Hybrid; USD 76,000 - 126,000; Full time

Benefits offered by this job

Hybrid Working

Paid family leave

401(k) with match

Well-being program

Tuition reimbursement

Employee networks

Job summary

QBE North America is seeking a Claims Specialist - Accident & Health (Medical Stop Loss) in a hybrid environment across Marblehead, MA and Atlanta, GA. The role focuses on delivering expert claims service, assessing policy coverage, investigating and negotiating claims, and collaborating with partners to support strategic outcomes.

Ideal candidates bring experience in claims management, insurance industry knowledge, and strong analytical and negotiation skills.

Qualifications

• Analytical thinking and problem solving required.
• Knowledge of insurance guidelines and policy changes.
• Experience in claims management or related field.
• Strong negotiation and stakeholder management abilities.

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 public.
• Provide claim management for various 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 meetings to share strategy and best practices.
• Identify and resolve issues non-compliant with policies and procedures.
• Assist with daily review of reports and ad hoc reporting.
• Mentor and coach junior staff as required.

Skills

Analytical thinking

Business process improvements

Claims settlement

Critical thinking

Customer service

Insurance analysis

Insurance claims management

Insurance policies

Intentional collaboration

Managing performance

Negotiation

Problem solving

Risk management

Sound judgment

Stakeholder management

Education

Tertiary degree or equivalent

Relevant insurance qualifications

Job description

QBE North America is seeking a Claims Specialist - Accident & Health (Medical Stop Loss) in a hybrid environment across Marblehead, MA and Atlanta, GA. The role focuses on delivering expert claims service, assessing policy coverage, investigating and negotiating claims, and collaborating with partners to support strategic outcomes.

Ideal candidates bring experience in claims management, insurance industry knowledge, and strong analytical and negotiation skills.