Accident and Health Senior Claims Specialist (Provider XS/ESL)

AXIS (AXIS Capital); Princeton (NJ); On-site; USD 104,000 - 138,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

Health and wellness programs

Retirement plans

Tuition reimbursement

Paid time off

Job summary

AXIS (AXIS Capital) is seeking an experienced Accident and Health Senior Claims Specialist to provide senior claims handling expertise across multiple product lines. The role requires strong understanding of HMO, excess medical, and high-severity claims, including oversight of Third-Party Administrators.

Qualified candidates should have 4-6 years of experience in Accident & Health claims management, auditing, and cost containment strategies. The position offers a base salary range of $104K – $138K along with a comprehensive benefits package.

Qualifications

• Prior experience with MGU oversight, including Stop Loss, Provider Excess, and Managed Care claims.
• Strong Accident & Health claims management experience, including medical claims and cost containment.
• Experience auditing and reviewing Third-Party Administrators.

Responsibilities

• Strong understanding of HMO, excess medical, stop-loss, and high-severity claims.
• Conduct annual and desk audits of MGUs and TPAs.
• Support the development and maintenance of guidelines for processing specialty A&H claims.

Skills

HMO claims knowledge

Claims management experience

Data analysis skills

Negotiation skills

Communication skills

Education

Bachelor’s degree or equivalent industry experience

Tools

Microsoft Office Suite

Power BI

Job description

This is your opportunity to join AXIS Capital – a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry.

At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work.

All qualified applicants will receive consideration for employment without regard to any protected characteristic, including age, color, disability, ethnicity, gender identity, marital status, national origin, pregnancy, race, religion, sex, sexual orientation, veteran status, or any basis prohibited by the laws that govern its operations.

Accident and Health Senior Claims Specialist

This position provides senior claims handling expertise across all product lines within the Accident and Health division, including claims adjudicated both in-house and by Third-Party Administrators (TPAs) and MGUs.

Primary products include, but are not limited to: Managed Care, HMO, Medical Excess, Provider Excess, and Employer Stop Loss. Additional Specialty products include Leisure Travel, Excess Accident, Pet, Firefighter Line of Duty, Limited Medical Benefits, and Voluntary Benefits (Accident Medical, Critical Illness, Vision, Dental, and Short-Term Disability).

What will you do in this role?

• Strong understanding of HMO, excess medical, stop-loss, and high-severity claims
• Knowledge of medical cost containment strategies and provider/network dynamics
• Understanding and handling of Specialty A&H products
• Conduct annual and desk audits of MGUs and TPAs, including preparation and presentation of audit findings and reports
• Assist with due diligence reviews of prospective TPAs and support onboarding processes
• Monitor and enforce oversight procedures for MGUs and TPAs
• Support the development and maintenance of guidelines for processing specialty A&H claims
• Review claims exceeding MGU and TPA authority thresholds, including second-level appeals
• Coordinate responses to complaints, attorneys, carrier reviews, and benefit clarifications
• Provide oversight of Provider Excess structures and HMO/Managed Care provider reimbursement
• Gather, analyze, and interpret monthly reporting data to identify trends and implement corrective action plans as needed
• Partner with underwriting, actuarial, and product development teams to communicate claim trends and insights
• Produce and review reports for management
• Lead special projects with multi-month planning horizons

About You

We encourage you to bring your unique experience and expertise. While we have identified key qualifications, we value diverse backgrounds and perspectives that can contribute to success in this role and the broader goals of the organization.

What you need to have

• Prior experience with MGU oversight, including Stop Loss, Provider Excess, and Managed Care claims
• Strong Accident & Health claims management experience, including medical claims and cost containment
• Experience auditing and reviewing Third-Party Administrators
• Knowledge of ERISA and applicable state claims handling requirements
• Exposure evaluation and reserving experience
• Bachelor’s degree or equivalent industry experience
• Insurance designation preferred
• 4-6 years of experience with stop-loss, HMO managed care, excess provider, captive programs including A&H products

What we prefer you to have

• Highly proficient in Microsoft Office Suite (Outlook, Word, Excel, PowerPoint)
• Strong analytical skills, including ability to interpret data; Power BI experience a plus
• Excellent written, negotiation, and communication skills
• Proven ability to work collaboratively, manage deadlines, and operate effectively in a dynamic environment
• Comfortable interacting across all levels of the organization and with external business partners

Role Factors

• Preferred candidates will be able to commute to an AXIS office three days per week
• Travel several times per year within the U.S. and Canada for on-site TPA audits

What do we offer

• Base salary range: $104K – $138K (based on experience and location)
• Competitive incentive compensation tied to corporate and individual performance
• Comprehensive benefits package including:
  • Medical, dental, and vision plans
  • Health and wellness programs
  • Retirement plans
  • Tuition reimbursement
  • Paid time off and additional benefits

Where this role is based in the United States, it is classified as exempt for FLSA purposes.